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HomeMy WebLinkAboutMercy House - 2016-09-19AMENDMENT NO. 1 TO HOME RECIPIENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE FOR TENANT BASED RENTAL ASSISTANCE THIS AMENDMENT is made and entered into by and between the CITY OF HUNTINGTON BEACH, a California municipal corporation, hereinafter referred to as "CITY," and MERCY HOUSE, a California nonprofit public benefit corporation, hereinafter referred to as "SUBRECIPIENT." WHEREAS, CITY and SUBRECIPIENT are parties to that certain agreement, dated September 19, 2016, entitled "Home Recipient Agreement Between the City of Huntington Beach and Mercy House (Tenant Based Rental Assistance)," which agreement shall hereinafter be referred to as the "Original Agreement," and CITY and SUBRECIPIENT wish to amend the Original Agreement to reflect the additional work to be performed by SUBRECIPIENT and the additional compensation to be paid in consideration thereof by CITY to SUBRECIPIENT, NOW, THEREFORE, it is agreed by CITY and SUBRECIPIENT as follows: 1. ADDITIONAL PAYMENT In consideration of the additional services to be performed by SUBRECIPIENT, CITY agrees to add an additional amount of HOME Funds of Thirty Thousand Two Hundred Twenty -Seven Dollars ($30,227.00). The new total not to exceed amount of HOME Funds shall be Five Hundred Eleven Thousand, Three Hundred Fifty -Five Dollars ($511,355.00). 18-6543/181671/W 2. REAFFIRMATION Except as specifically modified herein, all other terms and conditions of the Original Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by their authorized officers on _ ZI 2018. MERCY HOUSE, a California nonprofit corporation By: Larry Haynes print name ITS: Executive Director AND B i Lon print name ITS: (circle one) Secretar} Chief Financial Officer/Asst. Secretary - I, COUNTERPART 2 18-6543/181671/MV CITY OF HUNTINGTON BEACH, a' municipal corporation of the State of California ity anager INITIATED AND APPROVED: Deputy Director of Economic Development APPROVED AS TO FORM: Date: City Attorney Aw 2. REAFFIRMATION Except as specifically modified herein, all other terms and conditions of the Original Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by their authorized officers on LcE S , 2018. MERCY HOUSE, CITY OF HUNTINGTON BEACH, a a California nonprofit corporation municipal corporation of the State of By: print name ITS: Executive Director AND By: print name ITS: (circle one) Secretary/Chief Financial Officer/Asst. Secretary - Treasurer COUNTERPART 2 18-6543/181671/MV California y M ager ' f INITIATED AND APPROVED: D puty Directo f E onomic Development Receive and File Dept. ID ED 16-27 Page 1 of 2 Meeting Date: 9/19/2016 CITY OF HUNTINGTON BEACH REQUEST FOR. CITY COUNCIL ACTION MEETING DATE: 9/19/2016 SUBMITTED TO: Honorable Mayor and City Council Members SUBMITTED BY: Fred A. Wilson, City Manager PREPARED BY: Kenneth A. Domer, Assistant City Manager Kellee Fritzal, Deputy Director, Business Development SUBJECT: Approve and authorize execution of the Implementation of a Tenant -Based Rental Assistance (TBRA) Program between the City and Mercy House, approve an appropriation of funding for the program, and approve budget adjustments to various HOME budgets Statement of Issue: The City Council is asked to approve a two-year Agreement between the City and Mercy House in the amount of $481,128 for implementation of the Tenant -Based Rental Assistance (TBRA) Program for extremely -low and very -low income households. Of this amount, $389,128 will be funded by Federal HOME Investment Partnership and $92,000 will be funded by Housing In -Lieu Fees and Low and Moderate Income Housing Asset Funds. In addition, a budget adjustment is requested to expend funds from the Affordable Housing In -Lieu Fees and Federal HOME grant funds for the TBRA program and for other eligible HOME -funded programs. Financial Impact: There are sufficient revenues, available cash, and/or fund balances to support the above adjustments in Affordable Housing In -Lieu Fee Fund (217) and Low and Moderate Income Housing Asset Fund (352). Transfers are being requested for a total amount of $118,387 to the HOME FY 2015-16 grant fund to account for program income received that is available to expend on eligible HOME programs. See Attachment 2 for breakdown of funds. Recommended Action: A) Approve and authorize the City Manager and City Clerk to execute a two-year "HOME Recipient Agreement Between the City of Huntington Beach and Mercy House" for the implementation of a Tenant -Based Rental Assistance (TBRA) program and approve the budget adjustments for the amounts indicated above to reconcile the various HOME federal grant funds; and B) Authorize the City Manager to sign all necessary documents to effectuate the Agreement with Mercy House, any future minor amendments to contract, and/or US Department of Housing and Urban Development (HUD) documents, as approved to form by the City Attorney. Alternative Action(s): Do not approve and direct staff as necessary HB -189- Item 8. - I Dept. ID ED 16-27 Page 2 of 2 Meeting Date: 9/19/2016 Analysis: On July 7, 2016, the City issued a Notice of Funding Availability (NOFA) for estimated funds available between $700,000 and $1,000,000 in affordable housing funds. The City's goal was to obtain proposals for affordable housing projects. The City received four proposals (3 for affordable housing projects and 1 for a TBRA program). On August 9, 2016, the City received proposals from Orange County Community Housing Corporation (OCCHC), Jamboree, and Hope for acquisition/rehabilitation projects; and Mercy House for the implementation of a TBRA program. City staff reviewed the proposals and based on this review, Mercy House was selected to implement a TBRA program. Working with the City's Police Department (HBPD) and Homeless Coordinator, Mercy House proposes to set-up a TBRA program that will target homeless, veterans, and at -risk families and individuals with demonstrable ties to the City of Huntington Beach to meet their immediate needs and create pathways which will allow them to quickly move into stable, permanent housing. Funding will be used to provide short -to -medium -term rental assistance to households who are currently homeless or those who have exhausted other options and would become homeless without this funding. Mercy House aims to serve 17 households or approximately 17 individuals in the 2016-17 Fiscal Year. Mercy House has a deep level of experience administrating TBRA programs providing both rapid re -housing and homeless prevention services to homeless and at -risk individuals and families in multiple jurisdictions in Southern California including: Orange County, Santa Ana, Costa Mesa, and Ontario. On September 21, 2015, the City Council approved a TBRA Program with Interval House. Interval House has provided housing to 14 homeless households (35 people) which exceeded its goal of 9 homeless households. Interval House has been working with the City to house seniors, veterans, homeless, and domestic abuse victims into permanent housing. Annually, the City is allocated HOME funds from the US Department of Housing and Urban Development (HUD). Additional HOME grant funds that are required to be committed to eligible HOME programs have been identified and a budget adjustment is requested to appropriate and expend these funds. A TBRA program is eligible under HOME guidelines to allocate funds to provide a rental subsidy to individual households to afford housing costs such as rental assistance, security and utility deposits. It is staffs recommendation to approve and enter into the agreement with Mercy House as a sub -recipient of HOME funds to implement the City's TBRA program. A proposed Affordable Housing Agreement will be brought to the City Council at a future date regarding an acquisition / rehabilitation project solicited through the NOFA. Environmental Status: A Level of Environmental Review was completed and the program is Categorically Excluded, Not Subject to 58.5 per 24 CFR 58.34(a) and 58.35(b) Tenant -Based Rental Assistance (US Department of Housing and Urban Development). Strategic Plan Goal: Improve quality of life Attachment(s): 1) HOME Recipient Agreement between the City of Huntington Beach and Mercy House (Tenant -Based Rental Assistance) 2) Budget Appropriations and Transfers Item 8. - 2 HB -190- HOME RECIPIENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE (Tenant Based Rental Assistance) This HOME RECIPIENT AGREEMENT Tenant Based Rental Assistance) ("Agreement") is made and entered into as of /? ("Effective Date") by and between the CITY OF HUNTINGTON BEACH, municipal corporation and charter city ("City"), and MERCY HOUSE, a California nonprofit public benefit corporation ("Subrecipient"). RECITALS A. City is a California municipal corporation and charter city under the laws of the State of California. B. City has applied for and received funds ("HOME Funds") from the United States Department of Housing and Urban Development ("HUD") pursuant to the HOME Investment Partnerships Act and HOME Investment Partnerships Program, 42 U.S.C. §12701, et seq., and the implementing regulations set forth in 24 CFR § 92.1, et seq. (together, "HOME Program") for the purposes of strengthening public -private partnerships to provide more affordable housing, and particularly to provide decent, safe, sanitary, and affordable housing for very low income and lower income citizens of Huntington Beach in accordance with the HOME Program. As used herein, the HOME Program includes the HUD Final Rule set forth at 78 FR 142, adopted July 24, 2013, which adopts substantial amendments to the HOME Program regulations set forth at 24 CFR Part 92. C. City is currently implementing a coordinated multi -year strategy and program to provide financial assistance to eligible extremely low, very low and lower income families and households to enable such households to secure housing available at an affordable housing cost. D. City has developed and seeks to implement a Tenant Based Rental Assistance Program to assist households in the City, who are homeless or at imminent risk of homelessness, preference given to veterans and seniors, to enable such households to transition into permanent, supportive housing. E. City wishes to engage the Subrecipient to assist the City in utilizing HOME Funds to provide tenant based rental assistance and security deposits to households, who are homeless or at imminent risk of homelessness, with preference given to veterans and seniors, to enable such households to transition into permanent, supportive housing. 16-5435/ 143675/DO F. City wishes to use in -lieu fees generated from the City's Inclusionary Housing Ordinance (Inclusionary Funds) to fund administrative and programmatic costs that are ineligible under the HOME Program regulations. NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows: ARTICLE 1 SCOPE OF SERVICES 1.1 Scope of Services. During the entire Term (defined below) of this Agreement, Subrecipient shall administer the City's HOME -funded Tenant Based Rental Assistance Program ("TBRA Program'), all in accordance with this Article 1 (collectively, the "Services") and the TBRA Program Operating Guidelines attached hereto as Exhibit A. In connection with the Services, Subrecipient shall comply with all requirements of the HOME Program, this Agreement and all applicable federal, state and local laws and regulations. Subrecipient shall further take all reasonable actions necessary to enable City to comply with City's obligations under the HOME Program relating to the TBRA Program. The Subrecipient shall perform the Services set forth in this Article 1 in furtherance of the TBRA Program. 1.2 Marketing and Outreach; Application Process. (a) Marketing and Outreach. Subrecipient shall undertake affirmative marketing and outreach activities to find prospective Eligible Households interested in the TBRA Program, all in accordance with HUD's Affirmative Fair Housing and Marketing regulations and the City's Affirmative Fair Housing Marketing Plan, when adopted. Subrecipient shall describe its marketing and outreach efforts in quarterly progress reports submitted to the City under this Agreement, as described in Exhibit B. (b) Waiting List. Subrecipient shall maintain a waiting list of prospective Eligible Households. The waiting list shall be prioritized first based on the most urgent need as set forth in the TBRA Program Operating Guidelines, prospective Eligible Households of equally urgent need will be helped on a first come -first served basis, based on the date and time of referral or initial direct contact with the Subrecipient. (c) Intake Process. Upon being contacted by a prospective Eligible Household recruited through Subrecipent's affirmative marketing and outreach efforts, Subrecipient shall initially meet with such prospective Eligible Household to fill out an Initial Qualification Document in substantially the form attached as Appendix A to the TBRA Program 16-5435/143675/DO 2 Operating Guidelines, including an income calculation based on two months of source documentation (bank account statements, pay stubs, etc.) to prequalify such prospective Eligible Household. Subrecipient shall then meet with prequalified Eligible Households to determine and verify their qualifications and eligibility for assistance under the TBRA Program, provide such prequalified Eligible Households with the TBRA Program application and other documentation described below, assist prospective Eligible Households with the completion of the application and gross income calculation worksheet and qualify Eligible Households for the TBRA Program. Subrecipient shall provide every prequalified Eligible Household with all of the following documentation. (i) TBRA Application in the form attached to the TBRA Program Operating Guidelines as Appendix B, or as otherwise approved in writing by the Deputy Director of Business Development on behalf of the City ("Deputy Director'). The TBRA Application shall solicit information regarding each applicant household's income and assets, household size and composition (number of children and adults), names of household members, Housing Unit (defined below) size and location preferences, specific needs and considerations, and a race/ethnicity survey. (ii) Declaration of Homelessness Status as appropriate, in the forms attached to the TBRA Program Operating Guidelines as Appendix C. (iii) Rental Assistance Contracts for the Landlord and the Eligible Household, in the forms attached to the TBRA Program Operating Guidelines as Appendix D. (iv) Income Calculation Forms in the form attached to this Agreement as Exhibit C. (v) Household Budget Worksheet (Gap Analysis) in the form attached to this Agreement as Exhibit D. (vi) Lead -Based Hazard Information Pamphlet "Protect Your Family from Lead in Your Home" attached to this Agreement as Exhibit E. (d) Guidance for Eligible Households. Subrecipient shall meet with prospective Eligible Households throughout the application process and shall continue to meet with and counsel each Eligible Household regarding the TBRA Program, the Eligible Household's responsibilities as participants of the TBRA Program, and the goals and objectives of the TBRA Program. 16-543 5/ 143675/DO 3 1.3 Determination of Eligibility. Subrecipient shall qualify all Eligible Households in accordance with the selection criteria described in this Section. Further, for all Eligible Households Subrecipient shall implement the selection criteria and policies in compliance with the City's Consolidated Plan and the City's housing needs and priorities. (a) Eligible Household. As used in this Agreement, "Eligible Household" refers to extremely low income households that are (1) currently residents of the City of Huntington Beach, and (ii) currently homeless or at imminent risk of homelessness. (i) As used in this Agreement, "homeless" is defined at 24 CFR 91, 582 and 583, as defined by HUD. (ii) For purposes of determining eligibility for the TBRA Program, a prospective Eligible Household's (or for continuing compliance, a participating Eligible Household's) gross annual income shall be determined in accordance with 24 CFR 5.609, with the allowable exclusions from income established at 24 CFR 5.611. For purposes of this Agreement, annual income means the gross amount of income from all sources, including assets, for all adult household members that is anticipated to be received prospectively during the 12-month period following the date of application and before any deductions are taken (and for a participating household, income anticipated for the 12 months following verification described in §1.3(b)(ii) below.) When collecting income verification documentation, Subrecipient may also consider any likely changes in income. (iii) For purposes of this Agreement and the TBRA Program, income limits for extremely -low, very -low and low income households are established annually by HUD for the Orange County income limit area. (b) Income Verification. (i) Initial Verification. To determine if TBRA Program applicants (collectively, "Applicants") are income -eligible, Subrecipient must verify each Applicant's household income using source documentation such as wage statements, interest statements, unemployment compensation statements, bank account statements and other documentation types approved by HUD. Once an initial income verification is completed, the Subrecipient is not required to re-examine the Eligible Household's income unless six months has elapsed before assistance is provided. 16-5435/ 143675/DO 4 (ii) Annual Eligibility Verification. Subrecipient shall annually re- certify income and re -qualify each Eligible Household, including examination of source documentation. Household income must be no greater than 80% of AMI to remain eligible for assistance. For households found no longer eligible, assistance must be terminated following a 30-day notification period. (c) Verification of Eligibility. Subrecipient shall collect and examine source documentation submitted by the Applicant to verify the identity of the members of the Eligible Household. Subrecipient shall make a determination that the Eligible Household is currently experiencing homelessness or is at imminent risk of homelessness, as defined in the 24 CFR 91, 582 and 583, based on caseworker observations and certification and Applicant certification. (d) Notice of Eligibility Determination. Subrecipent shall provide written or documented verbal notice to each Applicant stating whether such Applicant was determined to be eligible for assistance under the TBRA Program. Applicants determined to be ineligible for TBRA Program assistance shall have an opportunity to appeal the determination to the Subrecipient's Executive Director. If the issue is not resolved, the case will be referred to the Deputy Director. The definition of "homelessness" under the 24 CFR 91, 582 and 583 is applicable to this Agreement. 1.4 Selection of Housing Units. (a) Housing Unit Selection. Subrecipient shall assist Eligible Households with finding and selecting an appropriate housing unit (each a "Housing Unit") that meets federal housing quality standards ("HQS") or such other standards as may be made applicable to the TBRA Program by HOME Program statutes and/or regulations, specifically including Uniform Physical Condition Standards (UPCS), and that satisfies the requirements of the TBRA Program, HOME Program and this Agreement. Eligible Households shall also be entitled to find a Housing Unit for themselves, subject to compliance with the requirements of the TBRA Program, HOME Program and this Agreement; however, the parties anticipate that in most cases, Subrecipient shall be responsible for locating and qualifying an appropriate Housing Unit for occupancy by each Eligible Household. Subrecipient may refer Eligible Households to appropriate Housing Units but may not require an Eligible Household to select a particular Housing Unit. Subsidy Payments shall only be provided in connection with the rental of a qualified Housing Unit located in the City, unless Subrecipient documents reason for selecting housing outside the city. Subsidy Payments under this Agreement are portable within the City. Subrecipient's obligations under this Section 1.4 apply to each Housing 16-5435/143675/DO 5 Unit to be occupied by an Eligible Household receiving Subsidy Payments hereunder. (b) Housing Unit Size; Occupancy Standards. Housing unit selection shall comply with the following "Occupancy Standards' for the applicable Eligible Household: No more than two persons per bedroom plus one may occupy the Housing Unit. Thus, no more than three persons may occupy a one bedroom Housing Unit, no more than five persons may occupy a two bedroom Housing Unit; no more than seven persons may occupy a three bedroom Housing Unit; no more than nine persons may occupy a four bedroom Housing Unit. (c) Property Inspection. Prior to occupancy of any Housing Unit by an Eligible Household, and again during the annual (or more often) verification process, Subrecipient shall cause a certified HQS inspector to inspect each Housing Unit occupied or to be occupied by an Eligible Household to ensure the Housing Unit complies with HQS as set forth in the HOME Program, including without limitation 24 CFR 92.251, as well as all applicable state and local codes and ordinances, including zoning ordinances. Subrecipient shall provide the City with documentation of each HQS inspector's certification. Each HQS inspection shall include all of the following: (i) Verification of the age of the Housing Unit (on Rent Reasonableness Form (Appendix G); (ii) Complete HQS Inspection Checklist in the form attached as Exhibit G, including a rating for the Housing Unit of Pass, Pass with Comment, or Fail; (iii) Lead -based hazard assessment, dissemination of lead -based hazard information pamphlet and disclosure form and lead -based hazard reduction activities, if required by the HOME Program or applicable federal, state and/or local laws; (iv) Adequate opportunity for the Landlord (defined below) to correct any deficiencies indicated in the HQS Inspection Form to bring the Housing Unit into compliance with HQS requirements; (v) Verification that occupancy by the Eligible Household will comply with the Occupancy Standards set forth in Section 1.4(b); and (vi) Certification of rent reasonableness regarding the rent being charged for the Housing Unit based on comparable non -assisted Housing Units in the same area. Subrecipient shall perform the rent reasonableness review as approved by the City. City may l 6-5435/143675/DO 6 elect to perform the rent reasonableness reviews on behalf of Subrecipient by providing written notice to Subrecipient. The rent charged under the written lease agreement for the Housing Unit shall conform to the Rent Reasonableness Standard pursuant to Appendix F of the TBRA Program Operating Guidelines, which is based on local market conditions. The contract rent for Housing Units that are restricted to an affordable rent by agreement with the City or by regulation or ordinance, or otherwise, shall be likewise restricted to such affordable rent in accordance with the contractual, statutory or regulatory restrictions governing the permitted rents for such Housing Units and the Rental Assistance Subsidy Payment shall be limited and calculated accordingly, as described in Section 1.5(a), below. (d) Coordination with Landlords. (i) Landlord Guidance. Subrecipient shall provide guidance to the property owners, property owners' representatives, or property management companies hired by property owners (each a "Landlord" and collectively referred to as "Landlords") participating in the TBRA Program regarding the TBRA Program requirements and procedures that impact Landlords. (ii) Landlord Agreement. Subrecipient shall enter into a Landlord Agreement with each participating property owner/Landlord in substantially the form attached to the TBRA Program Operating Guidelines as Appendix E. The Landlord Agreement will establish the Subsidy Payments to be made by Subrecipient on behalf of the Eligible Household as well as the Eligible Household's initial share of the contract rent. The Landlord Agreement shall further establish the terms and conditions under which the Subsidy Payments shall be paid to the Landlord for the applicable Housing Unit, including applicable HOME Program requirements. The Landlord Agreement shall have an initial term of 6-12 months, subject to extensions approved by Subrecipient and City (as applicable) pursuant to the TBRA Program Operating Guidelines. (iii) Tenant Protection Agreement. Subrecipient shall require each Landlord to enter into a lease agreement with a term of 12 months with any Eligible Household occupying a Housing Unit owned and/or managed by such Landlord, which lease agreement shall include a Tenant Protection Agreement in substantially the form attached to the TBRA Program Operating Guidelines as Appendix F, or an updated form of Tenant Protection Agreement as may be prepared and provided by the City to the Subrecipient, and then by Subrecipient to Landlord. The Tenant Protection Agreement shall 16-5435/143675/DO 7 be executed in connection with the lease agreement between the Landlord and Eligible Household. The Tenant Protection Agreement will prohibit the inclusion of prohibited lease terms listed at 24 CFR 92.253; Confirm the landlord's obligation to maintain the Housing Unit in accordance with HQS, as established at 24 CFR 982.401; and prohibit discrimination by the landlord against the Eligible Household. Mercy House will review the lease agreement to confirm its compliance with state law and all HOME Program requirements. If the Landlord's form of rental agreement is not acceptable, Subrecipient shall require the Landlord and Eligible Household to enter into a lease agreement that complies with state law, HOME requirements, and City requirements. 1.5 Subsidy Payments. Subrecipient shall make rent payments and security deposit payments, as applicable (collectively, the "Subsidy Payments"), to Landlords, on behalf of Eligible Households. Subsidy payments must be provided in accordance to the Subrecipient's TBRA Program Operating Guidelines. Eligible Households are not expected to repay Subsidy Payments received pursuant to the TBRA Program. Except as may be permitted by the HOME Program, Subrecipient's sole remedy in the event of noncompliance or breach by an Eligible Household shall be non -renewal of assistance under the TBRA Program. (a) Rental Assistance Calculation. Subrecipient shall calculate the "Rental Assistance" payments to be paid on behalf of each Eligible Household under this Agreement. The maximum amount of monthly assistance that Mercy House may pay on behalf of a family is the difference between the rent standard for the unit size and 30% of the household's monthly adjusted income. (b) Payment Standards. Subrecipient must use the payment standards as set forth in the Rent Reasonableness Standards attached to the TBRA Program Operating Guidelines as Appendix G. The payment standard represents the cost of rent and utilities for moderately priced units in Huntington Beach. Payment standards are established by bedroom size. (c) Utility Allowance. When utilities are included in the cost of renting a unit, that is, the owner assumes responsibility for payment for all utility services, the Eligible Households entire share of the housing costs will go directly to the owner. When the cost of utilities is not part of the rent, that is, the Eligible Household is directly responsible for payment of utility services, the Eligible Household's initial share of monthly rent will be determined by subtracting a utility allowance from 30% of the Eligible Household's gross monthly income. The Subrecipient must use the County of Orange's Housing Authority's Utility Allowance Schedule attached to the TBRA Program Operating Guidelines as Appendix H. 16-5435/143675/DO 8 (d) Term. The Subrecipient will provide rental assistance for an initial term of 6-12 months, which can be extended in 6-12 month intervals for a cumulative term of up to 24 months. Extensions will be granted at the discretion of the Subrecipient and shall be based on continued program compliance and ongoing need. The Subrecipient will evaluate ongoing need. (e) Security Deposit Assistance. Subrecipient may provide security deposit assistance to each Eligible Household. It is anticipated that Subrecipient shall provide Security Deposit Assistance to each Eligible Household in an amount no greater than 2 months' rent. The lease agreement must provide that the security deposit is refundable in accordance with state law. Security deposit refunds shall be provided by the Landlord directly to the Eligible Household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by Eligible Household and landlord, as provided for in the lease. (d) Utility Deposit Assistance. Subrecipient may provide utility deposit assistance to each Eligible Household. It is anticipated that Subrecipient shall provide Security Deposit Assistance to each Eligible Household in an amount no greater than 2 months' rent. The lease agreement must provide that the security deposit is refundable in accordance with state law. Security deposit refunds shall be provided by the Landlord directly to the Eligible Household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by Eligible Household and landlord, as provided for in the lease. 1.6 Administrative Cost Reimbursements The City will reimburse the Subrecipient for allowable costs incurred in administering the TBRA Program, which are associated with the determination of income eligibility, pursuant to 24 CFR 92.203, and property inspections under HQS, codified per 24 CFR 982.401. Administrative costs incurred in administering the TBRA Program that are ineligible under the HOME Program will be reimbursed from a non -HOME Program funding source, or Inclusionary Funds. The administrative costs to be reimbursed from the Inclusionary Funds include Intake Assessments, Housing Search, Case Management, Self -Sufficiency and related services and overhead. 1.7 Termination of Assistance and Returning Eligible Households. (a) Termination of Rental Assistance. Subrecipient may terminate assistance under the TBRA Program for any of the following reasons: (i) Eligible Household is evicted from the Housing Unit based on behavioral issues or unlawful activity; 16-5435/143675/DO 9 (ii) Eligible Household has violated TBRA participant agreement. (iii) Eligible Household will be assisted by another rental assistance program such as the Section 8 Tenant -Based or Project -Based Programs. Participation in any other rental assistance program is considered a duplicative subsidy therefore all HOME funded rental assistance must be terminated. 1.8 Returning Eligible Households. As needed, Eligible Households may be allowed to return to the program for rental assistance. A determination to allow re-entry shall be based on the following criteria: (i) Eligible Households must have left the program in good standing. To be in good standing, Eligible Households must have been engaged in their case management plan, voluntarily left the program (not in lieu of termination) or have been released because their household income exceeded eligibility limits. In general, Eligible Households will not be allowed to re-enter the program if they were terminated for non-compliance. (ii) At the discretion of the Subrecipient, a request for re -admission from a prospective Eligible Household previously terminated due to non-compliance may be considered when compelling reasons exist. In such cases, re -admission will require concurrence from the City. (iii) Eligible Households may return so long as the previous rental assistance did not exceed 24 months. Cumulatively, Eligible Households may not receive rental advice for more than a cumulative period of 24 months unless such assistance is permitted by the HOME Program and approved by the City. 1.9 Additional Requirements. (a) Self -Sufficiency Program. Subrecipient shall request each Eligible Household receiving Subsidy Payments from the Subrecipient to participate in Housing Stabilization Case Management administered by Subrecipient and in accordance with the Case Management and Self Sufficiency Program Policies and Procedures attached to the TBRA Program Operating Guidelines as Appendix I. Failure of an Eligible Household that is already receiving Subsidy Payments to participate in the Self -Sufficiency Program shall not be grounds for termination of the Subsidy Payments, but may be grounds for non -renewal of Subsidy Payments upon expiration of the subsidy term. 16-5435/143675/DO 10 (b) No Fees. Subrecipient may not charge fees to any Eligible Household for the Services, Subsidy Payments, Case Management or other services or assistance to be provided to Eligible Households under this Agreement. 1.10 Schedule of Performance. Subrecipient shall use its best efforts to perform the Services in accordance with the following schedule: (a) Affirmative marketing and outreach activities required by this Agreement shall commence immediately upon execution of this Agreement. (b) Subrecipient shall qualify Eligible Households, conduct HQS inspections, approve Housing Units, and move Eligible Households into approved Housing Units in accordance with the following milestone schedule: (1) Subrecipient shall process intake paperwork for and verify eligibility for TBRA Program assistance (`Enroll") for not fewer than three (3) Eligible Households within three (3) months following execution of this Agreement. As program income becomes available and/or additional HOME Funds are contributed to the TBRA Program, Subrecipient shall use diligent efforts to Enroll additional Eligible Households within not more than three (3) months following written notice from the City that such additional funds are expected to become available. (ii) Subrecipient shall assist each Enrolled Eligible Household in finding an appropriate Housing Unit and shall conduct an HQS inspection of such Housing Unit, all within two (2) months following Enrollment of such Eligible Household. (ill) Subrecipient shall commence providing Subsidiary Payments on behalf of each Eligible Household and shall assist each Eligible Household to move into an HQS-inspected and approved Housing Unit, all within three (3) months following Enrollment/Intake of such Eligible Household. (c) Subrecipient shall request each Eligible Household to commence participation in the self-sufficiency program immediately upon Enrollment of such Eligible Household, whether or not such Eligible Household has yet moved into a Housing Unit and received the benefit of Subsidy Payments hereunder. 1.11 City Oversight and Approval Rights. City shall have the right, by written notice to Subrecipient at any time during the Term of this Agreement, to require City review of any of the Services to be performed or pre -approval of service tools and procedures by Subrecipient hereunder, including for example income determinations, qualification of applicants as "Eligible Households," qualification 16-5435/143675/DO 11 of Housing Units, determination of reasonable rents, etc., to ensure compliance with the TBRA Program, the HOME Program, or other applicable requirements. ARTICLE 2 TERM 2.1 Term. Services of the Subrecipient under this Agreement shall start on 9/20/2016 and end on the earlier to occur of (1) 9/30/2018 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) below has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets, including program income. ARTICLE 3 BUDGET AND PAYMENTS 3.1 Budget. Subrecipient has submitted a budget to City for approval ("Budget"), which sets forth the estimated timing and use of the HOME Funds and Inclusionary Funds contributed by the City pursuant to this Agreement. The Budget is attached hereto as Exhibit F. Any amendments to an approved Budget for the Services must be approved by the City's Director or his authorized designee. In the event this Agreement is extended past the initial Term or any additional moneys will be contributed to the TBRA Program by City pursuant to this Agreement, Subrecipient shall prepare and submit to the Deputy Director for approval an updated Budget for such additional moneys. Subrecipient shall prepare a Budget, for approval by Deputy Director, for each year during which this Agreement remains in effect. The City may require a more detailed line item breakdown of the Budget than the one contained herein, and the Subrecipient shall provide such supplementary information about the Budget in a timely fashion in the form and content prescribed by the City. 3.2 Reimbursement of Subsidy Payments. City shall reimburse Subrecipient for Subsidy Payment actually disbursed to or on behalf of Eligible Households pursuant to this Agreement and in accordance with line items on the approved Budget or as otherwise approved by the City's Deputy Director. City shall have no obligation to reimburse Subrecipient for ineligible administrative costs or expenses incurred by Subrecipient to manage or implement the TBRA Program or this Agreement, for the cost of social or supportive services provided to Eligible Households hereunder, or for any other costs or expenses incurred by Subrecipient in connection with its activities under this Agreement. City's payment obligations hereunder shall be limited to the actual amount of Subsidy Payments disbursed by Subrecipient and eligible administrative costs in accordance with the terms of this Agreement and the approved Budget. Payments 16-5435/143675/DO 12 may be contingent upon certification of the Subrecipient's financial management system in accordance with the standards specified in 24 CFR 84.21. (a) Amount of Payments. It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed Three Hundred Eighty -Nine Thousand One Hundred Twenty -Eight Dollars ($389,128.00), or One Hundred Ninety - Four Thousand Five Hundred Sixty -Four ($194,564) annually. The amount of Inclusionary Funds to be paid by the City under this Agreement shall not exceed Seventy -Two Thousand Dollars ($72,000), or Thirty -Six Thousand Dollars ($36,000) annually. The dollar amounts stated in the immediately preceeding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of Subrecipient and the Director. (b) Requests for Payments. To receive each payment under this Agreement, Subrecipient shall submit to the City a written reimbursement request or invoice in a form approved by City, along with such supporting documentation as may be requested by the City to verify Subrecipient's performance of the Services for which the payment is requested. Reimbursement requests shall be submitted no more frequently than one time per month. Payments will be adjusted by the City in accordance with fund advances, if any, balances available in Subrecipient accounts. In addition, the City reserves the right to liquidate funds available under this Agreement for costs incurred by the City on behalf of the Subrecipient. 3.3 Payments Subject to Availability of HOME Funds. City's obligation to provide payments to Subrecipient hereunder is subject to City's receipt of HOME Funds from HUD pursuant to the HOME Program. 3.4 Accounting. Subrecipient shall, upon request, provide City with an accounting report, in form and content reasonably satisfactory to City, of any funds disbursed by City pursuant to Section 3.2. ARTICLE 4 INSURANCE AND INDEMNIFICATION 4.1 Insurance. Without limiting City's right to indemnification, Subrecipient shall secure prior to commencing the performance of any Services under this Agreement, and maintain during the Term of this Agreement, insurance coverage as set forth in this Section. (a) Workers' Compensation. For the duration of this Agreement, the Subrecipient and all subcontractors, consultants, and agents shall maintain Workers' Compensation Insurance in the amount and type required by California Law, if applicable. 16-5435/143675/DO 13 (b) Insurance. The Subrecipient, in order to protect the City, its agents, officers and employees against all claims and liability for death, injury, loss and damage as a result of the Subrecipient's or any and all Subrecipient actions in connection with this Agreement and the services required hereunder, shall secure and maintain for the duration of this Agreement insurance as described below. 1. Commercial general liability insurance with a combined single limit of not less than one million dollars ($1,000,000) per occurrence. Claims made and modified occurrence policies are not acceptable. Such insurance shall include completed operations liability, personal injury liability, and broad form property damage coverage. Such insurance, to be obtained from a reliable insurance carrier authorized to do such insurance business in the State of California, shall (a) expressly name the City, its agents, officers, and employees as additional insured; and (b) by primary with respect to any insurance or self-insurance programs maintained by the City or any other person or company; and (c) contain cross liability provisions and waiver of subrogation rights acceptable to the City. 2. Commercial automobile liability insurance with a combined single limit of not less than one million ($1,000,000) per occurrence. Such insurance shall include completed operations liability, personal injury liability, and broad form property damage coverage. Such insurance, to be obtained from a reliable insurance carrier authorized to do such insurance business in the State of California, shall (a) expressly name the City, its agents, officers and employees as additional insured; and (b) be primary with respect to any insurance or self-insurance programs maintained by the City or any other person or company; and (c) contain cross - liability provisions and waiver of subrogation rights acceptable to the City. 3. If the Subrecipient employs any person for the purpose of providing any and all advise, counseling and/or treating clients, the Subrecipient shall secure and maintain professional liability insurance (E&O coverage) with a limit of not less than one million dollars ($1,000,000). 4. Employment Practices Liability insurance in amounts commercially available and reasonably available to Subrecipient. 5. Such other insurance coverage or amounts reasonably requested in writing by the City. The Subrecipient shall furnish evidence of the 16-5435/143675/DO 14 insurance required herein, satisfactory to City Manager and the City's Risk Manager, consisting of certified copies of insurance policies and endorsements or properly executed certifications of insurance to the City in form and substance acceptable to the City and evidencing the required insurance prior to receiving funds under this agreement or commencement of services under this Agreement, whichever occurs first. Such certificates or policies shall: (i) Require thirty (30) days written notice to City, by certified mail, of any cancellation or reduction in available limits, or changes in the terms of coverage; (ii) Clearly evidence all coverage required above, including, if certificates are provided, attachment to any certificates of insurance a separate additional insured endorsement page (Form No. CG 20 10 11 85) naming the City and its agents, officers, and employees, as additional insured; and (iii) Indicate whether coverage is on a claims made or occurrence basis. Such insurance shall be maintained prior to commencement until completion of work under this Agreement, if an occurrence policy form is used. If a claims made policy is used, overage shall be maintained during the term of this Agreement and for a period extending five (5) years beyond the Agreement termination date. The Subrecipient shall replace such certificates for policies expiring prior to completion of work under this Agreement and shall continue to furnish certificates five (5) years beyond that time, when and if the Subrecipient has claims made form(s). All insurance shall be issued by a company or companies listed in the current "Best Key Rating Guide: publication with a minimum of a "B+, V" rating; or in special circumstances, as pre -approved by the City Clerk and City Attorney. Insurance coverage in the minimum amounts set forth herein shall not be construed to relieve the Operating Agency from Liability in excess of such coverage, or shall it preclude the City from taking such other actions as are available to it under any provision of this Agreement or otherwise in law. If the Subrecipient, for any reason, fails to maintain insurance coverage, which is required pursuant to this Agreement, the same shall be deemed a material breach of this Agreement. The City, at its sole option, may terminate this Agreement and obtain damages from the Subrecipient resulting from said breach. Alternatively, the City may purchase such required insurance coverage without further notice to the Subrecipient. 16-5435/143675/DO 15 The City may deduct from sums due to the Subrecipient any premiums and associated costs advanced by the City for such instances. If the balance of monies obligated to the Subrecipient pursuant to this Agreement is insufficient to reimburse the City for the premiums and any associated costs, the Subrecipient agrees to reimburse the City for the premiums and pay for all costs associated with the purchase of said insurance. 4.2 Indemnification. (a) As respects acts, errors or omissions in the performance of Services under this Agreement, the Subrecipient agrees to defend, indemnify and hold harmless City, its officers, agents, employees, representatives and volunteers from and against any and all claims, demands, defense costs, liability or consequential damages of any kind or nature arising directly out of the Subrecipient's negligent acts, errors or omissions in the performance of Services under the terms of this Agreement. (b) As respects all acts or omissions which do not arise directly out of the performance of Services, including but not limited to those acts or omissions normally covered by general and automobile liability insurance, Subrecipient agrees to indemnify, defend (at City's option), and hold harmless City, its officers, agents, employees, representatives, and volunteers from and against any and all claims, demands, defense costs, liability, or consequential damages of any kind or nature arising out of or in connection with Subrecipient's performance or failure to perform, under this Agreement; excepting those which arise out of the sole negligence of City. ARTICLE 5 ADMINISTRATIVE REQUIREMENTS 5.1 Financial Management. (a) Accounting Standards. Subrecipient agrees to comply with 24 CFR 84.21 through 84.28 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. (b) Cost Principles. Subrecipient shall administer its program in conformance with OMB Circulars A-122, "Cost Principles for Non -Profit Organization." These principles shall be applied for all costs incurred whether charged on a direct or indirect basis. 5.2 Documentation, Recordkeeping, Reporting and Monitoring. Subrecipient shall maintain documents and records, prepare and submit reports, and permit 16-5435/143675/DO 16 City to monitor Subrecipient's activities all in accordance with the requirements set forth in Exhibit B and applicable laws and regulations. All requirements set forth in such Exhibit B are incorporated herein as if set forth in full in this Agreement. 5.3 Program Income. Not applicable. 5.4 Use and Reversion of Assets. The use and disposition of property and equipment under this Agreement shall be in compliance with the requirements of 24 CFR Part 84 and 24 CFT 92.504, as applicable. The Subrecipient shall transfer to the City any HOME Funds on hand and any accounts receivable attributable to the use of HOME Funds under this Agreement at the time of the earliest to occur of expiration, cancellation, or termination. 5.5 Ownership of Documents. All documents and materials, both tangible and intangible, furnished by or through the City to Subrecipient pursuant to this Agreement are and shall remain the property of City and shall be returned to City upon the earliest to occur of expiration, cancellation, or termination of this Agreement. All documents and materials prepared by Subrecipient under or related to this Agreement shall become the property of City at the time of payment to Subrecipient of all fees, if any, for their preparation, and shall be delivered to City by Subrecipient at the request of City, and in any event upon the earliest to occur of expiration, cancellation, or termination of this Agreement. ARTICLE 6 PERSONNEL & PARTICIPANT CONDITIONS 6.1 Civil Rights. (a) Compliance. The Subrecipient agrees to comply with the Huntington Beach Municipal Code, Government Code Section 4450, et seq., the Unruh Civil Rights Act, Civil Code Section 51, et seq., 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 1 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 Executive Order 11246 as amended by Executive Orders 11375, 11478, 12107 and 12086. (b) Nondiscrimination. The Subrecipient agrees to comply with (1) the requirements of 24 CFR Part 5, subpart A, which relate to nondiscrimination and equal opportunity; (2) the nondiscrimination requirements of Section 282 of the HOME Investment Partnerships Act, 42 U.S.C. Section 12701, et seq_ 16-5435/143675/DO 17 (c) Section 504. The Subrecipient agrees to comply with all federal regulations issued pursuant to compliance with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), which prohibits discrimination against the individuals with disabilities or handicaps in any federally assisted program. 6.2 Affirmative Action. (a) Executive Order 11246. The Subrecipient agrees that it shall be committed to carry out pursuant to the City's specifications an Affirmative Action Program in keeping with the principles as provided in President's Executive Order 11246 of September 24, 1966. (b) Women- and Minority -Owned Businesses (W/MBE). The Subrecipient will use its best efforts to afford small businesses, minority business enterprises, and women's business enterprises the maximum practicable opportunity to participate in the performance of this Agreement. As used in this Agreement, the term "small business" means a business that meets the criteria set forth in Section 3(a) of the Small Business Act, as amended (15 U.S.C. 632), and "minority and women's business enterprise" means a business at least fifty-one percent (51%) owned and controlled by minority group members or women. For the purpose of this definition, "minority group members" are Afro-Americans, Spanish-speaking, Spanish surnamed or Spanish -heritage Americans, Asian -Americans, and American Indians. The Subrecipient may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. (c) Equal Employment Opportunity and Affirmative Action (EEO/AA) Statement. The Subrecipient will, in all solicitations or advertisements for employees placed by or on behalf of the Subrecipient, state that it is an Equal Opportunity or Affirmative Action employer. (d) Subcontract Provisions. The Subrecipient will include the provisions of Sections 6.1, Civil Rights, and 6.2, Affirmative Action, in every subcontract or purchase order, specifically or by reference, so that such provisions will be binding upon each of its own sub-subrecipients or subcontractors. 6.3 Employment Restrictions. (a) Prohibited Activity. The Subrecipient is prohibited from using HOME Funds, provided herein or personnel employed in the administration of the program for: political activities; inherently religious activities; lobbying; political patronage; and nepotism activities. (b) Labor Standard. The Subrecipient agrees to comply with the 16-5435/143675/DO 18 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 (40 U.S.C. 327 et seq.) and all other applicable federal, state and local laws and regulations pertaining to labor standards insofar as and when those acts apply to the performance of this Agreement. The Subrecipient agrees to comply with the Copeland Anti -Kick Back Act (18 U.S.C. 874 et seq.) and the implementing regulations thereto issued by the U.S. Department of Labor at 29 CFR Part 5. The Subrecipient shall maintain documentation that demonstrates compliance with applicable hour and wage requirements. (c) Prevailing Wage. The Subrecipient agrees that, to the extent applicable, all contractors engaged under contracts for construction, renovation or repair work financed in whole or in part with assistance provided under this Agreement shall comply with the regulations of the Department of Labor, under 29 CFR Parts 1, 3, 5 and 7 and California Labor Code Section 1720, et seq. governing the payment of wages and ratio of apprentices and trainees to journey workers. The Subrecipient 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. The Subrecipient agrees, to the extent applicable, to comply with Section 3 of the HUD Act of 1968, as amended, and as implemented by the regulations set forth in 24 CFR 135. 6.4 Conduct. (a) Assignment. The Subrecipient shall not assign or transfer any interest in this Agreement without the prior written consent of the City thereto; provided, however, that claims for money due or to become due to the Subrecipient 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. (b) Subcontracts. (i) Approvals. The Subrecipient shall not enter into any subcontracts with any entity, agency or individual in the performance of this Agreement without the written consent of the City prior to the execution of such agreement. (ii) Monitoring. The Subrecipient will monitor all subcontracted services on a regular basis to assure contract compliance. Results of monitoring efforts shall be summarized in written reports and 16-5435/143675/DO 19 supported with documented evidence of follow-up actions taken to correct areas of noncompliance. (iii) Content. The Subrecipient 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. (iv) Selection Process. The Subrecipient shall undertake to insure that all subcontracts let in the performance of this Agreement shall be awarded on a fair and open competition basis in accordance with applicable procurement requirements. Executed copies of all subcontracts shall be forwarded to the City along with documentation concerning the selection process. (c) Hatch Act. The Subrecipient agrees that no funds provided, nor 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 of the U.S.C. (d) Conflict of Interest. The Subrecipient agrees to abide by the provisions of 24 CFR 84.42 and 92.356, which include (but are not limited to) the following: (i) The Subrecipient shall maintain a written code or standards of conduct that shall govern the performance of its officers. employees or agents engaged in the award and administration of contracts supported by HOME Funds. (ii) No employee, officer or agent of the Subrecipient shall participate in the selection, or in the award, or administration of, a contract supported by HOME Funds if a conflict of interest, real or apparent, would be involved. (iii) No covered persons who exercise or have exercised any functions or responsibilities with respect to HOME -assisted activities, or who are in a position to participate in a decision -making process or gain inside information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the HOME - assisted activity, or with respect to the proceeds from the HOME - assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for a period of one (1) year thereafter. For purposes of this paragraph, a "covered person includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the City, the Subrecipient, or any designated public agency. 16-5435/143675/DO 20 (e) Lobbying. The Subrecipient hereby certifies that: (i) 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; (ii) 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; and (iii) It will require that the language of paragraph (iv) of this certification 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. (f) Lobbying Certification. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352 Title 31, US.C. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. (g) Religious Activities. The Subrecipient agrees that funds provided under this Agreement will not be utilized for inherently religious activities such as worship, religious instruction, or prose] ytizati on. ARTICLE 7 GENERAL CONDITIONS 7.1 General Compliance. The Subrecipient agrees to comply with the requirements of the HOME Program in the administration and implementation of the TBRA Program and this Agreement. The Subrecipient shall carry out each activity in 16-5435/143675/DO 21 compliance with all regulations described in subpart H of 24 CFR Part 92, except that the Subrecipient does not assume the City's responsibilities for environmental review under 24 CPR 92.352 and the intergovernmental review process described in 24 CFR 92.357 does not apply to the Subrecipient. The Subrecipient also agrees to comply with all other applicable federal, state and local laws, regulations, and policies governing the funds provided under this Agreement. The Subrecipient further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available. 7.2 Familiarity with Services; Qualified Personnel. (a) By executing this Agreement, Subrecipient represents and warrants that Subrecipient (i) has thoroughly investigated and considered the Services to be performed, (ii) has carefully considered how the Services should be performed, and (Ili) fully understands the requirements, difficulties and restrictions attending the performance of the Services under this Agreement. (b) Subrecipient represents that Subrecipient has or will secure and maintain, at Subrecipient's sole cost and expense, all qualified and licensed personnel required to perform the Services. Staff and any additional personnel hired by Subrecipient shall be employees of Subrecipient. Such personnel shall not be deemed to be employees of City or to have any contractual relationship with City. Such Personnel shall be authorized or permitted under state and local law to perform the Services. 7.3 Independent Contractor. In performing under this Agreement, Subrecipient is and shall at all times be acting and performing as an independent contractor to City, performing its duties in accordance with its own judgment. City shall neither have nor exercise any control or direction over the methods by which Subrecipient performs its work and function nor shall City have the right to interfere with such freedom or action or prescribe rules or otherwise control or direct the manner in which such services are performed. The sole interest of the City in the Services performed by the Subrecipient is that such Services be performed in a legal competent, efficient and satisfactory manner. Nothing contained herein shall cause the relationship between the parties to this Agreement to be that of employer and employee. Subrecipient shall not have the authority to obligate City to any contract, obligation, or undertaking whatsoever and shall make no representation, either oral or in writing. 7.4 Subrecipient Representative. Subrecipient hereby designates Patti Long, Operations Director as its Project Manager for the TBRA Program ("Subrecipient's Representative"). Subrecipient's Representative shall supervise and direct the Services, using his or her best skill and attention, and shall be 16-5435/143675/DO 22 responsible for all means, methods, techniques, sequences and procedures and for the satisfactory coordination of all portions of the Services under this Agreement. 7.5 Nepotism. Subrecipient shall not hire or permit the hiring of any person to fill a position funded through this Agreement if a member of the person's immediate family is employed in an administrative capacity by City's HOME Program or any department of the City which is administering the HOME Program. For the purposes of this section, the term "immediate- family' means spouse, child, mother, father brother, sister, brother-in-law, sister-in-law, father-in-law, mother- in-law, son-in-law, daughter-in-law, aunt, uncle, stepparent and stepchild. The term "administrative capacity" means having selection, hiring, supervisory or management responsibilities, including serving on the governing body of City. 7.6 Hold Harmless. The Subrecipient shall indemnify, hold harmless, and defend the City and their elected officials, officers, employees and agents and shall pay for expenses incurred by the City for any and all claims, actions, suits, charges and judgments whatsoever related in any manner to or that arise out of the Subrecipient's performance or nonperformance of the Services or subject matter called for in this Agreement. 7.7 City Recognition. The Subrecipient shall insure recognition of the role of the City in providing Services through this Agreement. All activities, facilities and items utilized pursuant to this Agreement shall be prominently labeled as to funding source. 7.8 Notices. Any approval, disapproval, demand, document or other notice ("Notice") which any party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by reputable document delivery service such as Federal Express that provides a receipt showing date and time of delivery, (iii) facsimile transmission, or (vi) mailing in the United States mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below, or at any other address as that parry may later designate by Notice. Service shall be deemed conclusively made at the time of service if personally served; upon confirmation of receipt if sent by facsimile transmission; the next business if sent by overnight courier and receipt is confirmed by the signature of an agent or employee of the party served; the next business day after deposit in the United States mail, properly addressed and postage prepaid, return receipt requested, if served by express mail; and three (3) days after deposit in the United States mail, properly addressed and postage prepaid, return receipt requested, if served by certified mail. 16-5435/143675/DO 23 Subrecipient: Larry Haynes Executive Director Mercy House PO Box 1905 Santa Ana, CA 92702 City: City Clerk City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 With copies to: Kellee Fritzal Office of Business Development 2000 Main Street Huntington Beach, CA 92648 Such addresses may be changed by Notice to the other party(ies) given in the same manner as provided above. 7.9 Amendment and Waiver. This Agreement may be amended, modified, or supplemented only by a writing executed by each of the parties. Any party may in writing waive any provision of this Agreement to the extent such provision is for the benefit of the waiving party. No action taken pursuant to this Agreement, including any investigation by or on behalf of any party, shall be deemed to constitute a waiver by that party or its or any other party's compliance with any representations or warranties or with any provision of this Agreement. 7.10 Entire Agreement. This Agreement, including all Exhibits attached hereto, embodies the entire agreement and understanding between the parties pertaining to the subject matter of this Agreement and supersedes all prior agreements, understandings, negotiations, representations, and discussions, whether verbal or written, of the parties pertaining to the subject matter. In the event of a conflict between this Agreement, on one hand, and any Exhibit attached hereto, on the other hand, the provisions of this Agreement shall control; provided, if it is possible to comply with the requirements of this Agreement and the Exhibits, the parties shall do so. The following Exhibits are attached to this Agreement and incorporated herein: Exhibit A TBRA Program Operating Guidelines Appendix A Initial Qualification Form Appendix B TBRA Application Appendix C Declaration of Homelessness 16-5435/143675/DO 24 Appendix D Rental Assistance Contract Appendix E Landlord Agreement Appendix F Lease Addendum Appendix G Rent Reasonableness Standard Appendix H Orange County Housing Authority Utility Allowance Schedule Appendix I Case Management and Self Sufficiency Program Policies and Procedures Exhibit B Documentation, Recordkeeping, Reporting and Monitoring Requirements Exhibit C Gross Income Calculation Form Exhibit D Household Budget Worksheet Exhibit E Lead -Based Hazard Information Pamphlet "Protect Your Family from Lead in your Home" Exhibit F Budget Exhibit G Housing Quality Standards (HQS) Inspection Checklist 7.11 Governing Law. The validity, construction, and performance of this Agreement shall be governed by the laws of the State of California. 7.12 Non -Liability of Members, Officials and Employees of City. No member, official or employee of City shall be personally liable to Subrecipient, or any successor in interest, in the event of any Default or breach by City or for any amount which may become due to Subrecipient or Subrecipient's successors, or on any obligation under the terms of this Agreement. Subrecipient hereby waives and releases any claim Subrecipient may have against the member, officials or employees of City with respect to any Default or breach by City or for any amount which may become due to Subrecipient or Subrecipient's successors, or any obligations under the terms of this Agreement. Subrecipient makes such release with the full knowledge of Civil Code Section 1542 and hereby waives any and all rights thereunder to the extent of this release, if such Section 1542 is applicable. Section 1542 of the Civil Code provides as follows: "A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO 16-5435/143675/DO 25 EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR." ARTICLE 8 ENFORCEMENT; TERMINATION 8.1 Events of Default. (a) For purposes of this Agreement, the word "Default" shall mean the failure of Subrecipient to perform any of Subrecipient's duties or obligations or the breach by Subrecipient of any of the terms and conditions set forth in this Agreement; any failure by Subrecipient to comply with any of the rules, regulations or provisions referred to herein, or such statutes, regulations, executive orders, and HUD guidelines, policies or directives as may become applicable at any time; any ineffective or improper use of funds provided under thisAgreement; or submission by the Subrecipient to the City reports that are incorrect or incomplete in any material respect. In addition, Subrecipient shall be deemed to be in Default upon Subrecipient's (i) application for, consent to, or suffering of, the appointment of a receiver, trustee or liquidator for all or a substantial portion of its assets, (ii) making a general assignment for the benefit of creditors, (iii) being adjudged bankrupt, (iv) filing a voluntary petition or suffering an involuntary petition under any bankruptcy, arrangement, reorganization or insolvency law (unless in the case of an involuntary petition, the same is dismissed within thirty (30) days of such filing), or (v) suffering or permitting to continue unstayed and in effect for fifteen (15) consecutive days any attachment, levy, execution or seizure of all or a substantial portion of Subrecipient's assets or of Subrecipient' s interests hereunder. (b) City shall not be deemed to be in Default in the performance of any obligation required to be performed by City hereunder unless and until City has failed to perform such obligation for a period of thirty (30) days after receipt of written notice from Subrecipient specifying in reasonable detail the nature and extent of any such failure; provided, however, that if the nature of City's obligation is such that more than thirty (30) days are required for its performance, then City shall not be deemed to be in Default if City shall commence to cure such performance within such thirty (30) day period and thereafter diligently prosecute the same to completion. 8.2 Institution of Legal Actions. In addition to any other rights and remedies, and subject to the restrictions otherwise set forth in this Agreement, either party may institute an action at law or in equity to seek the specific performance of 16-5435/143675/DO 26 the terms of this Agreement, to cure, correct or remedy any Default, to recover damages for any Default or to obtain any other remedy consistent with the purpose of this Agreement. Such legal actions must be instituted in the Superior Court of the County of California, State of California or in the United States District Court for the Central District of California. 8.3 Acceptance of Service of Process. In the event that any legal action is commenced by the Subrecipient against City, service of process on City shall be made by personal service upon the City Clerk or in such other manner as may be provided by law. In the event that any legal action is commenced by City against the Subrecipient, service of process on the Subrecipient shall be made by personal service upon Subrecipient's Representative or in such other manner as may be provided by law. 8.4 Rights and Remedies Are Cumulative. Except as otherwise expressly stated in this Agreement, the rights and remedies of the parties are cumulative, and the exercise by either party of one or more of such rights or remedies shall not preclude the exercise by it, at the same or, different times, of any other rights or remedies for the same Default or any other Default by the other party. 8.5 Inaction Not a Waiver of Default. Any failures or delays by either party in asserting any of its rights and remedies as to any Default shall not operate as a waiver of any Default or of any such rights or remedies, or deprive either such party of its right to institute and maintain any actions or proceedings which it may deem necessary to protect, assert or enforce any such rights or remedies. 8.6 Attorney's Fees. City and Subrecipient agree that in the event of litigation to enforce this Agreement or terms, provisions and conditions contained herein, to terminate this Agreement, or to collect damages for a Default hereunder, the prevailing party shall not be entitled to costs and expenses, including reasonable attorney's fees, incurred in connection with such litigation, such that each party shall be responsible for their costs and attorneys' fees. 8.7 Termination. (a) Termination for Cause. In accordance with 24 CFR 85.43, the City may suspend or terminate this Agreement in the event of a Default by the Subrecipient under this Agreement. Subrecipient may suspend or terminate this Agreement if City fails to make payments to Subrecipient as required herein. (b) Termination for Convenience. In accordance with 24 CFR 85.44, this Agreement may also be terminated for convenience by either the City or the Subrecipient, in whole or in part, by setting forth the reasons for such termination, the date the termination will be effective, and, in the case of partial termination, the portion to be terminated. However, if in the case 16-5435/143675/DO 27 of a partial termination, the City determines that the remaining portion of the award will not accomplish the purpose for which the award was made, the City may terminate the award in its entirety. IN WITNESS WHEREOF, the parties have executed this HOME Recipient Agreement (Tenant Based Rental Assistance) as of the Effective Date, which is the date of the City Council approving this Agreement. SUBRECIPIENT: MERCY HOUSE, a California nonprofit corporation By: `-J print name ITS: Executive Director AND , 13 print name ITS: (circle one) Secretary/ Chief Financial Officer/Asst. Secretary —Treasurer CITY: CITY OF HUNTINGTON BEACH, a municipal goWgrgtion and charter city LIZA ATTEST: By: Ci lerk APPROVED ity Attorney DV-0 (kVQWo ty V TED AND APPROVED: By: zr�—d 6:�') Deputy Director of oonomic Development RE94-AJA`*M-anager ND PR ED: By:City 16-5435/143675/DO 28 of a partial termination, the City determines that the remaining portion of the award will not accomplish the purpose for which the award was made, the City may terminate the award in its entirety. IN WITNESS WHEREOF, the parties have executed this HOME Recipient Agreement (Tenant Based Rental Assistance) as of the Effective Date, which is the date of the City Council approving this Agreement. SUBRECIPIENT: MERCY HOUSE, a California nonprofit corporation US print name ITS: Executive Director AND IIn CITY: CITY OF HUNTINGTON BEACH, a municipal corporation and charter city By: Pi4f*nager ATTEST: By: �a City Clerk APPROVED AS ,FORM: print name ITS: (circle one) Secretary/ By: Chief Financial Officer/Asst. Secretary — Treasurer ity Attorney F, ,.V TED AND APPROVED: By: Deputy Director of onomic Development REV ED ND PR ED: By: /` stant City Manager 16-5435/143675/DO 28 Exhibit A TBRA Program Operating Guidelines City of Huntington Beach Tenant -Based Rental Assistance Program Operating Guidelines Program Overview The City of Huntington Beach (City) has established a Tenant -Based Rental Assistance (TBRA) program (Program) that follows all the requirements of the HOME Program, as set forth in the HOME Program under Section 24, Part 92, of the code of Federal Regulations (24 CFR 92). In 2016, the City published a Request for Proposals (RFP) and selected Mercy House to administer the Program through 2018. The City will evaluate the impact of the Program on homeless individuals and families at the end of the term to determine the merits of extending the program and the effectiveness of the services provided by Mercy House. Key indicators of success will include the ability to transition off the Program and remain housed without assistance for at least six months, increases in earned income, and sustainable rent burden (at or below 30% of family income). The Program will provide short and medium -term rental assistance was well as housing relocation and stabilization services for homeless and at -risk of homeless households from Huntington Beach, who have extremely -low income. The Program will meet the City's Investment Criteria by targeting program assistance up to 18 homeless households, all with incomes at or below 30%AMI and preference given to veterans, seniors and victims of domestic violence. The procedures set forth herein establish the tenant selection guidelines for the Program, provide the necessary operating structure for the Program and clarify the roles and responsibilities of Mercy House and the City. II. Marketing, Outreach and Application Process A. Marketing and Outreach Mercy House is responsible for marketing and outreach activities to find prospective Eligible Households interested in the Program. Mercy House will conduct community presentations, outreach, training to community organizations, and participate in community events to educate on TBRA resources available. Additionally, Mercy House will continue to partner with Huntington Beach Police Department, OC211, Huntington Beach Homeless Task Force, and other housing providers to refer eligible residents of Huntington Beach eligible for TBRA assistance. Mercy House will provide quarterly reports to the City that shall describe the marketing and outreach efforts for the quarter. All marketing need to be done to meet all affirmative marketing requirements. B. Waiting List Once the Program has reached maximum enrollment, estimated at 28 households over the two-year contract period, Mercy House shall maintain a waiting list of prospective Eligible Households. This list will be prioritized as follows: ■ Clients who have been assessed for TBRA eligibility, completed intake process, and ready for housing placement. ■ Clients who have been assessed for TBRA eligibility, completed intake process, and searching for housing. ■ Clients who have been assessed for TBRA eligibility and pending intake. ■ Ready for housing placement means that the household has found a housing unit that meets TBRA requirements (many landlords won't accept third party payments, rent requested by landlord is too high, won't allow unit inspection, etc.) ■ Priority ranking will be given for Homeless Category 1 (24 CRF 91, 582 and 583) - literally homeless participants will come from the streets or other locations not meant for human habitation, emergency shelters, or safe havens. Targeted preference will be given to veterans, seniors, and victims of domestic violence (Homeless Category 4) to support the City's investment priorities. Within these categories, households will be helped on a first come — first served basis, based on the date and time of application completed. C. Intake Process As part of the intake process, Mercy House will meet with the prospective Eligible Household to conduct a needs assessment and complete an Initial Qualifications Form (Appendix A). If the Program has reached maximum capacity, Mercy House shall review the applicant to assess if other services may be offered while the applicant is waiting for a slot to open in the Program. As part of the intake process, Mercy House shall also request and/or assist the prospective Eligible Household with the completion of the following documents: ■ TBRA Application (Appendix B) ■ Declaration of Homeless Status or Declaration of At -Risk of Homelessness Status (Appendix C) D. Guidance for Eligible Households Mercy House will meet with the prospective Eligible Households throughout the application process and will continue to meet with and counsel each Eligible Household regarding the Program, the Eligible Household's responsibilities as participants of the Program, and the goals and objectives of the Program. III. Determination of Eligibility The Program will utilize HOME Program funds for supportive services and rental assistance. As such, the applicants must meet the eligibility qualifications of the HOME Program. Eligibility for services offered by the Program shall adhere to the following selection criteria: A. Income Eligible Households ■ To receive supportive services as well as rental assistance under the HOME Program, the Applicant's total household income must be at or below 30% of the Orange County area median income (AMI). However, once the Applicant is part of the Program, the household income can increase up to 80% of the AMI before Mercy House must give notice of termination from the Program. ■ Income limits for extremely -low income households are established annually for the HOME Program by HUD for the Orange County income limit area. ■ Gross Annual Income shall be determined in accordance with 24 CFR 5.609, with the allowable exclusions from income established at 24 CFR 5.611. Gross Annual Income means the gross amount of income from all sources, including assets, for all adult household members that is anticipated to be received prospectively during the 12-month period following the date of application and before any deductions are taken. ■ Mercy House will determine and verify eligibility for assistance under the Program through the review of income source documents. As outlined in the revised HOME rules published in July 2013, applicants must provide evidence of income for the two (2) most recent months. Acceptable source documents include wage statements, check stubs, entitlement verification from another government agency and bank statements. The definition of income for the purposes of the Program is located at 24 CFR Part 5 (often referred to as the Section 8 definition). In cases where no evidence of income (third -party verification) is available, Mercy House may allow clients to self -report their income. In such cases, Mercy House staff will provide a written explanation for why they were unable to obtain third -party verification or documentation. ■ Mercy House may also consider any likely changes in income when collecting income verification documentation. ■ Initial income verifications are valid for six months. If admission to the Program takes longer than 6 months, income verifications must be updated and reevaluated. After initial verification, income recertification shall be conducted annually. ■ Income verifications will be used for two purposes: To determine eligibility for services. A determination of eligibility will be completed as part of the admissions process and thereafter annually. Income information will be used to establish the household's initial contribution toward rent, which shall be set at 30% of the household income. The household's initial contribution will remain unchanged for at least six months. B. Current Residents of the City of Huntington Beach Due to the nature of the population served by the Program, it may not be possible to obtain traditional proof of residency documentation such as utility bills. The following documentation can be accepted to establish that an applicant household qualifies for the Huntington Beach live/work preference: ■ Documentation from a Huntington Beach school that the children in the household have been enrolled in and attending the school for at least the last 90 days from the time of admission into the Program. ■ Documentation from a partner agency, such as the Huntington Beach Police Department, evidencing that the family is known to be homeless in Huntington Beach. ■ Proof that the applicant's last place of stable residency was in the City of Huntington Beach. Verification from a landlord is acceptable. ■ Proof that an adult member of the household is working or has been recently hired to work in Huntington Beach. C. Currently Homeless or At -Risk of Homelessness ■ At -Risk of Homelessness refers to a household that is at imminent risk of being evicted due to an economic hardship in paying rent or staying current with rent. (Category 2 of HUD Homeless Definition) ■ Homelessness refers to a household who meets the HUD Homeless Definition at 24 CRF 91, 582 and 583: Category 1 (literally homeless) and Category 4 (fleeing/attempting to flee violence and living in a place described in Category 1). D. Preferences The following summarizes the populations that Mercy House will target (note that the total percentages do not total to 100%): Program-• Populations Veterans 14% Seniors 14% Homeless 100% E. Annual Eligibility Verification ■ Mercy House will requalify each Eligible Household, including examination of source documentation, on an annual basis. ■ Mercy House may request that a participating Eligible Household provide verification(s) more often than annually, as reasonably necessary to confirm continued qualification and eligibility for the Program. ■ Mercy House will provide written notice to each applicant stating whether the Eligible Household was determined to be eligible for continued assistance under the Program. IV. Selection of Housing A. Housing Unit Selection Eligible Households must be residents of Huntington Beach and may elect to rent any Housing Unit in the City so long as the unit meets federal housing quality standards (HQS) or such.other standards as may be made applicable to the Program by HOME Program statues and/or regulations, specifically including Uniform Physical Condition Standards (UPCS) and passes a rent reasonableness test. Due to the nature of the population served by the Program, it is expected that Mercy House will assist Eligible Households with finding and selecting an appropriate Housing Unit that meets all program requirements. If an appropriate Housing Unit cannot be located within the City boundaries, a Housing Unit can be located outside of the City boundaries when housing is not suitable within City boundaries. While Mercy House can refer Eligible Households to appropriate Housing Units, households may not be required to select a particular Housing Unit. Rental assistance under the Program is only provided for Housing Units that meet the criteria established by the City of Huntington Beach HOME/TBRA Program. B. Occupancy Standards The number of persons in each Eligible Household will determine the required unit type. Each household must comply with the two per bedroom plus one occupancy standard. The following table provides the occupancy standards by unit type: C. Property Inspections Prior to occupancy of any Housing Unit by an Eligible Household, and again during the annual verification process, Mercy House will have a certified HQS inspector, inspect each Housing Unit to ensure the unit complies with HQS as set forth in the HOME Program (24 CFR 92.251), as well as all applicable state and local codes and ordinances, including zoning ordinances. Each HQS inspection will include the following: ■ Verification of the age of the Housing Unit (on Rent Reasonableness Form); Completed HQS Inspection Form (HUD-52580); Lead -based paint hazard assessment, dissemination of lead -based paint information pamphlet and disclosure form and lead -based paint reduction activities, if required; Adequate opportunity for landlord to correct any deficiencies indicated in the HQS Inspection form to bring the Housing Unit into compliance; and Verification that occupancy by the Eligible Household will comply with occupancy standards. The HQS Inspection Form is located in Appendix D. D. Rent Reasonableness Rental assistance paid on behalf of the Eligible Household must be in compliance with federal Rent Reasonableness requirements which require that rents paid by or on behalf of assisted households be similar to rents paid by non -assisted households. Rent Reasonableness reviews will be performed by Mercy House. The factors listed below shall be considered when determining rent comparability: ■ Location and age; ■ Unit size including the number of rooms and square footage or rooms; The type of unit including construction type (e.g., single family, duplexes, garden, low-rise, high- rise); The quality of the unit, which includes the building construction, maintenance and improvements; and Amenities, services and utilities included in the rent. Mercy House will follow both the rent reasonableness regulations established for the Housing Choice Voucher (HCV) program at 24 CFR 982.507 to evaluate rents. In the event that a rent request does not meet rent reasonableness requirements, Mercy House shall attempt to negotiate a lower rent with the property owner. If the owner is not willing to accept a lower rent, the household must be instructed to search for another unit. Under no circumstances shall Mercy House or the assisted household agree to pay more than approved through the rent reasonableness review. Additionally, the assisted household is not allowed to make up any difference in the rent offer. E. Coordination with Landlords Mercy House will meet with and provide guidance to landlords participating in the Program regarding the requirements and procedures that impact landlords. i. Landlord Agreement (Appendix E) ■ Mercy House will enter into a Landlord Agreement with each participating landlord or property owner. The Landlord Agreement will establish the security deposit assistance payment and the initial rental assistance payments to be paid on behalf of the household. The Agreement will also establish the participating household's initial share of the contract rent. The Agreement will also require the landlord to provide Mercy House with notice of a lease termination, and reaffirm the tenant protections included in the Tenant Protection Agreement. ■ The Eligible Household's share of rent will be re-evaluated every 6 months. ■ This contract will have an initial term of 12 months. ii. Tenant Protection Agreement (Appendix F) ■ The landlord will be required to enter into a lease agreement with a term of 12 months with any Eligible Household occupying a Housing Unit. ■ The lease agreement will include a Tenant Protection Agreement that will be executed in connection with the lease between the landlord and the Eligible Household. ■ The Tenant Protection Agreement will include the following elements: ■ Prohibit the inclusion of the following provisions in the lease, as required by 24 CFR 92.253: ■ (1) Agreement to be sued; ■ (2) Treatment of property; ■ (3) Excusing owner from responsibility; ■ (4) Waiver of notice; ■ (5) Waiver of legal proceedings; ■ (6) Waiver of a jury trial; ■ (7) Waiver of right to appeal court decision; ■ (8) Tenant chargeable with cost of legal actions regardless of outcome; and ■ (9) Mandatory supportive services. ■ Confirm the landlord's obligation to maintain the Housing Unit in accordance with HQS, as established at 24 CFR 982.401. 0 Prohibit discrimination by the landlord against the Eligible Household. Mercy House will review the lease agreement to confirm its compliance with state law and all HOME Program requirements. V. Payment Standards, Rent Calculation, Term and Subsidy Reductions As authorized by HOME TBRA regulations, the Program will rely on a traditional rental assistance calculation. The model allows for the rent subsidy determination based on 30% of household income. A. Rent Assistance Calculation Mercy House will complete a rental assistance calculation for each Eligible Household. The calculation will determine each household's Program subsidy and share of the rent. The maximum amount of monthly assistance that Mercy House may pay on behalf of a family is the difference between the rent standard for the unit size and 30% of the household's monthly adjusted income. Each household's maximum rent subsidy will vary since the calculation involves the use of individualized factors such as the household's actual income and family size. The initial household contribution to rent will remain unchanged for at least six months. Minimum tenant contribution to rent under the Program is set at $50.00. This minimum is used if the maximum subsidy calculation would result in the household paying less than $50.00 towards the monthly rent (e.g. if 30% of the household's monthly adjusted income is less than $50.00). This minimum contribution may be waived in exceptional circumstances. B. Rent Reasonableness Standards The Program must use the Rent Reasonableness Standard (Appendix G) to calculate monthly rental assistance. The payment standards represent the cost of rent and utilities for moderately priced units in Huntington Beach. Payment standards are established by bedroom size. When utilities are included in the cost of renting a unit, that is, the owner assumes responsibility for payment for all utility services, the household's entire share of the housing costs will go directly to the owner. When the cost of utilities is not part of the rent, that is, the household is directly responsible for payment of utility services, the household's initial share will be determined by subtracting a utility allowance from 30% of the household's income. Mercy House must use the Orange County Housing Authority utility allowance schedule (Appendix H) to determine the household's utility allowance. In these cases, the household's share of the rent is equal to 30% of the household's monthly adjusted income minus the applicable monthly utility allowance. Each household is responsible for paying their rent share directly to the landlord each month. If a selected Housing Unit is subject to contractual, statutory and/or regulatory affordability restriction, the monthly rental assistance payments will not exceed the difference between the required affordable rent amount for the Housing Unit and 30% of the Eligible Household's monthly adjusted income. Participant Agreement (Appendix J) Mercy House will enter into a Participant Agreement with each participating client household. The Participant Agreement will establish the Eligible Household's responsibilities towards rent payments. The Agreement will establish the participating household's initial share of the contract rent, which will be adjusted every 6 months. ii. Term Mercy House will provide rental assistance for an initial term of 6 months, which can be extended every 6-12 months, for a cumulative term of up to 24 months. Extensions will be granted at the discretion of Mercy House and shall be based on continued Program compliance and ongoing need. Mercy House will utilize the Gap Analysis and Income Re -Evaluation to assess ongoing need and adjust household's share of rent as appropriate. Households with income above 60% AM will be notified about income eligibility limits. iii. Subsidy Reductions The participant's household income will be reevaluated every six months. If the household income has increased since the previous evaluation, the participant's monthly rent responsibility will be adjusted accordingly per Rent Assistance Calculation as stated in above section V. A. VI. Security Deposits As needed, Mercy House will provide security deposit assistance to Eligible Households. Such assistance shall be the lesser of: o Two months approved rent for the Housing Unit; or o The standard security deposit required by the landlord for non -subsidized tenants. Security deposit assistance provided to participating households will be in the form of a grant. As such, the landlord can provide a security deposit refund directly to the household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by the tenant and landlord, as provided for in the lease. VII. Utility Deposits As needed, Mercy House will provide utility deposit assistance to Eligible Households. Such assistance shall be standard security deposit required by the utility provider for non -subsidized tenants. Utility deposit assistance provided to participating households will be in the form of a grant. As such, the utility provider can provide a utility deposit refund directly to the household. Any disputes involving the return, or lack thereof, of a utility deposit shall be settled by the tenant and the utility provider. The Utility deposit subsidies cannot be used as a stand-alone activity. The assistance must be utilized with rental subsidy, security deposit subsidy, or both. VIII. Annual Recertification, Termination of Assistance and Returning Households A. Annual Recertification Recertification of income and Program eligibility will occur annually. Mercy House will gather source documentation for participating households to determine annual income. Annual income must be calculated in accordance with 24 CFR Part 5. If the total household income is above 80% AMI, rental assistance must be terminated following a 30 day notification period. B. Termination of Rental Assistance Assistance can be terminated for the following reasons: ■ Eviction from the assisted rental unit based on behavioral issues and/or unlawful activity. ■ The family will be assisted by another rental assistance program such as the Section 8 Tenant -Based or Project -Based program. Participation in any other rental assistance program is considered a duplicative subsidy therefore all HOME funded rental assistance must terminate. C. Returning Participant Households As needed, participants may be allowed to return to the Program for either support services, rental assistance or both. A determination to allow re-entry shall be based on the following criteria: • Participants must have left the Program in good standing. To be in good standing, participants must have been engaged in their case management plan, voluntarily left the program (not in -lieu of termination) or have been released because their household income exceeded eligible limits. In general, participants will not be allowed to re-enter the Program if they were terminated for non- compliance. At the discretion of Mercy House, a request for readmission from a non -compliant household may be considered when compelling reasons exist. In such cases, re -admission will require concurrence from the City. The Participant's previous rental assistance did not exceed 24 months. Cumulatively, participants will only be allowed to receive rental assistance for a maximum of 24 months. IX. Program Requirements This program is designed to provide supportive housing services that will assist the participants in becoming self-sufficient prior to the termination of TBRA assistance. Recipients are required to participate in Mercy House's self-sufficiency programs as a condition of initial assistance. Program participant during the program is strongly encouraged, but is not mandatory. Failure to continue to participate in the program during the contract will not result in termination from the program. However, participants that do not continue to participate in the self-sufficiency program may not be renewed for additional rental assistance. A. Case Management The Mercy House Case Management model maximizes client success by developing individualized service plans and addressing clients' specific needs in securing permanent housing and self-sufficiency. Clients will meet with their Case Manger on a minimum of a monthly basis to update goals, monitor progress, and ensure long-term housing stability. Self-sufficiency groups are also held weekly to assist with financial management, job development, life skills, personal empowerment, and accessing other resources needed to gain housing stability. B. Individualized Housing and Service Plan Participants meet with their Case Manager at intake and at least monthly to review their Goal Worksheet and Individualized Service Plan to help establish and identify participant goals and plans for housing, education, employment, financial (including budgeting and credit repair), legal, and other housing stabilization and relocation resources needed. C. Housing Search and Placement Mercy House employs Leasing Agents to assist clients with comprehensive housing search and placement into affordable permanent housing. Leasing agents have formed relationships with landlords and management companies to provide referrals to clients. D. Legal Services Case Managers will provide referrals to lawyers, legal advocates and volunteer attorneys to provide comprehensive legal services and representation in multiple languages. Legal assistance includes lease agreements, legal advocacy, court accompaniment, and other legal issues affecting homeless and at -risk homeless persons and their children. E. Employment Assistance Obtaining self-sufficiency is a critical goal for families served by Mercy House. Mercy House Case Managers work with clients to identify interests, life experiences and talents that lend themselves to employment. Housing Advocates also: ■ Help clients develop resumes, complete job application and prepare for interviews; E Obtain educational scholarships through AmeriCorps and other sources to increase leadership skills and/or further their education; ■ Provide transportation solutions to job interviews and job -related activities; and ■ Provide job placement in career -level jobs and job retention assistance. F. Transportation If available, Housing Stabilization Case Managers will provide transportation assistance including bus passes or gas vouchers to assist clients in attending important housing, employment, medical, and legal appointments. Eligible clients will be connected to free and low-cost transportation services including OCTA Access or reduced cost bus passes. At no point will Mercy House staff transport clients in personal vehicles. G. Behavioral Health Mercy House provides an array of individual and group counseling programs on -site and works closely with other mental health providers to address behavioral health needs of participants. Appendices Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H Appendix I Initial Qualification Form (MH) TBRA Application Form (MH) Declaration of Homelessness Status (MH) Rental Assistance Contract (MH) Landlord Agreement (MH) HOME Program Lease Addendum (MH) Rent Reasonableness and Fair Market Rent Certification (MH) Utility Allowance Chart (MH) Case Management & Self -Sufficiency Program Policies and Procedures (MH) Appendix A Initial Qualification Form HMIS Intake and Enrollment Form - General Client Name/ID: Identification (All fields required unless otherwise noted) HMIS consent? - No (refused) ❑ Signed Consent Form First Name: Last Name: Middle Name (Optional): Suffix (Optional): Name Data Quality: Physical Description (Optional): Last Known Permanent Address: Did the client provide their full Where have you last lived for 90 days or more? name? Not including emergency shelters and transitional housing) - Full Name Reported Address: - Partial, street name, or code City: name reported - Client Doesn't Know County: - Client Refused Data not Collected Date of Birth: SSN: State: - Full DOB reported - Full SSN reported - Approximate or partial DOB - Approximate or partial SSN Zip: reported reported - Client Doesn't Know - Client Doesn't Know Address ❑ Full address reported ❑ Client Doesn't Know - Client Refused - Client Refused Data ❑ Incomplete or estimated ❑ Client Refused - Data not Collected - Data not Collected Quality: address reported ❑ Data not Collected Phone Number Phone Type Contact Preference - Home ❑ Work ❑ Phone Main: () x ❑ Leave message - Cell ❑ Message ❑ Alternate Phone Center ❑ Text ❑ Home ❑ Work ❑ Email Alternate: O- x ❑ Leave message ❑ Cell ❑ Message Center Email @ Notes Housing Status: Family Type: Category 1 - Homeless Client Doesn't Know ❑ Unaccompanied - Category 2 — At Imminent Risk of Losing Housing (within 14 days or less) ❑ Client Refused ❑ Single Parent ❑ Category 3 — Homeless only under other Federal Statutes ❑ Data not Collected ❑ Two Parents ❑ Category 4 — Fleeing Domestic Violence ❑ Adults No children ❑ At Risk of Homelessness ❑ Stably Housed 1 HMIS Intake and Enrollment Form - General Client Name /ID. Relation to Head of Household Gender: ❑ Self ❑ Male Client Doesn't Know ❑ Head of Household's Child ❑ Female - Client Refused ❑ Head of Household's Spouse or Partner ❑ Transgender Female to Male I Data not Collected ❑ Head of Household's other Relation Member ❑ Transgender Male to Female ❑ Other: Non -relation Member ❑ Other (Specify: Disabled? Veteran Education Level (Physical, Developmental, Mental Health, (Have you ever served in (What is the highest level of education you've completed?) Chronic Health Condition, HIV/RIDS, the U.S. Military?) and/or Substance Use Disorder. Yes Yes ❑ No Schooling Completed ❑ 12th Grade, no diploma - No No ❑ Nursery School to 4th Grade ❑ High School Diploma Client Doesn't Know Client Doesn't Know ❑ 51h or 611 Grade ❑ GED - Client Refused Client Refused ❑ 7th or 8th Grade ❑ Post -Secondary School _ Data not Collected Data not Collected ❑ 9th Grade ❑ 4-year College Degree ❑ 101h Grade ❑ Graduate School ❑ 111h Grade ❑ Unknown Ethnicity Race check all that apply) - Non -Hispanic C Asian ❑ Client Doesn't Know Hispanic ❑ Black or African American - Client Refused Client Doesn't Know C Native Hawaiian or Other Pacific Islander E Data not Collected - Client Refused C American Indian or Alaska Native ❑ Data not Collected ❑ White Income Source (Check all that apply) Stated Income Pay Interval Weekly _Every Other Week Twice A Month Monthly Quarterly Yearly = No financial resources ❑ Earned Income (employment wa es / cash $ ❑ ❑ ❑ ❑ ❑ ❑ Fl Unemployment Insurance $ ❑ ❑ ❑ C Supplemental Security Income SSI $ ❑ — — — ❑ Social Security Disability Income (SSDI) $ ❑ — ❑ ❑ ❑ VA Service -Connected Disability Compensation $ ❑ — ❑ ❑ - VA Non -Service -Connected Disability Pension $ ❑ — ❑ ❑ ❑ ❑ - Private Disability Insurance $ ❑ ❑ ❑ ❑ ❑ ❑ Workers Compensation $ ❑ — ❑ ❑ ❑ Temporary Assistance for Needy Families CalWORKs $ ❑ ❑ ❑ ❑ ❑ - General Assistance GA General Relief GR $ ❑ — ❑ — ❑ Retirement Income from Social Security $ ❑ _ "71- ❑ ❑ - Pension or retirement income from a former job $ ❑ _ ❑ ❑ n_ ❑ ❑ Child Support $ ❑ ❑ C - ❑ - Alimony or otherspousal support $ ❑ — — ❑ Other Source (Specify: $ ❑ — ❑ ❑ ❑ - Client Doesn't Know Client Refused ❑ Data not Collected HMIS Intake and Enrollment Form - General Client Name/ID: Income Documentation (Optional): Comments (Optional): ❑ GR Form ❑ CaIWORKS Forms ❑ Pension Letter/Stub Pay Stub ❑ Unemployment Insurance Forms ❑ Unemployment Forms ❑ Utility Allowance ❑ W-2 Forms ❑ Self Declaration ❑ Child Support Forms ❑ SSDI Form ❑ Employer Printout/Letter ❑ Social Security Forms ❑ Workmans Comp ❑ VA Documentation ❑ SSI Forms ❑ Self Employment Docs Non -Cash Benefits Check all that apply): None ❑ Client Doesn't Know ❑ Client Refused ❑ Data not Collected ❑ Food Stamps (CalFresh) ❑ CalWorks Child Care ❑ Temporary Rental Assistance Amount: ❑ CalWorks Transportation ❑ Section 8 or Rental Assistance ❑ Medically Needy ❑ WIC ❑ Other CalWorks-Funded Services ❑ Other Amount: Health Insurance (Check all that apply): No Health Insurance ❑ Client Doesn't Know ❑ Client Refused ❑ Data not Collected MEDICAID ❑ MEDICARE ❑ State Children's Health Ins. ❑ VA Medical Services - Employer Provided Health Ins. ❑ COBRA Health Ins. ❑ Private Health Ins. ❑ MediCal Client Note (Optional) 7= Client Note: Type: ❑ Information ❑ Alert Private Customer: ❑ Yes ❑ No Note Date: 1 I Contact Type Phone Number PhoneType Email Alternate Contact ❑ Home (Who is the best person to get in ❑ Cell touch with you?) ❑ Work Relationship: ()- X ❑ Message Center First Name: Last Name: Emergency []Home (In case of an emergency, who ❑ Cell should we alert?) ❑ Work ❑ Same as above (_)_- X ❑ Message Center Relationship: First Name: Last Name: Revised 312/'2016 3 HMIS ke Enrollment I and / General Program Entry (All fields required unless otherwise noted) Program Name: Case Manager: Program Entry Date: 1. Where did you sleepsslast night? ❑ Emergency shelter Rental by client, with GPD TIP subsidy ❑ Foster care home or foster care group home ❑ Rental by client, with other (non-VASH) ongoing housing subsidy Hospital or other residential non -psychiatric medical facility* Residential project or halfway house with no homeless criteria ❑ Hotel or motel paid for without emergency shelter voucher ❑ Safe Haven Jail, prison or juvenile detention facility* ❑ Staying or living in a family member's room, apartment, or house Long-term care facility or nursing home Staying or living in a friend's room, apartment or house Owned by client, no ongoing housing subsidy - Substance abuse treatment facility or detox center* Owned by client, with ongoing housing subsidy ❑ Transitional housing for homeless persons Permanent housing for formerly homeless persons - Other Place not meant for habitation - Client Doesn't Know Psychiatric hospital or other psychiatric facility* ❑ Client Refused Rental by client, no ongoing housing subsidy Data not Collected Rental by client, with VASH housing subsidy 1a. If "Other" prior residence was selected, pleasespecify (Required only if"question#1 was answered as "Other" 2. How long was your stay? One day or less* ❑ One to three months* ❑ Client Doesn't Know Two days to one week* ❑ More than three months, but less than one year ❑ Client Refused ❑ More than one week but less than one month* ❑ One year or longer ❑ Data not Collected 3. Client entering from the streets, ES, or SH? ❑ Yes ❑ Client Doesn't Know ❑ Data not Collected ❑ No ❑ Client Refused 3a. Approximate date started (Required only if the previous question was answered 'Yes' I I 4. Number of times the client has been on the streets, in ES, or SH in the ast three years including today. ❑ Never in three years ❑ Three times ❑ Client Doesn't Know ❑ One time ❑ Four or more times ❑ Client Refused Two times ❑ Data not Collected 4a. Total number of months homeless on the streets, in ES, :orSH in the past three years (Required only if question #4 was answered as'1, 2, 3, or or more times' ❑ One month (this time is the first month) ❑ 7 C 12 ❑ 2 ❑ 8 ❑ More than 12 months -_3 ❑ 9 ❑ Client Doesn't Know ❑ 4 1110 ❑ Client Refused ❑ 5 ❑ 11 C Data not Collected ❑6 IntakeHMIS •Enrollment•General HOMELESSNESS - Adults aged 18 and older and Head of Household < 18 years old, required questions are shaded Question < Check One Answer Comments 5. Where were you sleeping prior to - Emergency shelter entering the institutional setting mentioned - Foster care home or foster care group home above (in question #1)? - Hospital or other residential non -psychiatric medical facility Hotel or motel paid for without emergency shelter voucher (Required if question #2 was answered - Jail, prison or juvenile detention facility as three months or less (*) AND question - Long-term care facility or nursing home #1 was answered as one of the following - Owned by client, no ongoing housing subsidy (*): Owned by client, with ongoing housing subsidy -"Hospital or other residential non- - Permanent housing for formerly homeless persons psychiatric medical facility" - Place not meant for habitation -"Jail, prison or juvenile detention - Psychiatric hospital or other psychiatric facility facility" - Rental by client, no ongoing housing subsidy -"Psychiatric hospital or other - Rental by client, with VASH housing subsidy psychiatric facility" - Rental by client, with GPD TIP subsidy -"Substance abuse treatment facility - Rental by client, with other (non-VASH) ongoing housing or detox center" subsidy Residential project or halfway house with no homeless criteria Safe Haven Staying or living in a family member's room, apartment, or house - Staying or living in a friend's room, apartment or house Substance abuse treatment facility or detox center - Transitional housing for homeless persons - Other Client Doesn't Know - Client Refused Data not Collected 6. What city were you residing in Aliso Viejo Irvine San immediately prior to entry into this project? - Anaheim , La Habra Clemente Atwood La Palma - San Juan Balboa Laguna Beach Capistrano - Brea n Laguna Hills - Santa Ana Buena Park - Laguna Niguel _ Seal Beach' Capistrano Beach I Laguna Woods Stanton - Corona del Mar - Lake Forest - Sunset Costa Mesa - Las Flores Beach - Coto de Caza - Lemon Heights Tustin Cypress Los Alamitos - Villa Park' Dana Point - Midway City - Westminster El Modena -7 Mission Viejo - Yorba Linda Fountain Valley Newport Beach Outside Fullerton Orange Orange County Garden Grove = Placentia - Client - Huntington Beach - Rancho Santa Doesn't Know Margarita -, Client Refused Data not Collected 7. Was the client referred to this project - Yes through Coordinated Entry? - No —(Required for PSH projects only) Kea sed 01_. HMIS Intake and Enrollment Form - General Client Name/ID: Question Check One Answer Comments 8. Have you been diagnosed with AIDS or have you tested positive ❑ No Client Doesn't Know for HIV? E Yes** ❑ Client Refused`' ❑ Data not Collected 8a. Do you expect this to substantially impair your ability to live E No Client Doesn't Know independently? C Yes - Client Refused (Required if question 8 is `Yes') Data not Collected 8b. Do you have documentation of the disability and severity on file? C No Yes (Required if question 8 is `Yes' 8c. Are you currently receiving services/treatment for this E No Client Doesn't Know disability? ❑ Yes -' Client Refused (Required if question 8 is `Yes') C Data not Collected 9. Do you have a chronic health condition? ` ❑ Client Doesn't Know ❑ No ❑ Client Refused ❑ Yes" E Data not Collected 9a. Do you expect this to be of long —continued and indefinite 0 No C Client Doesn't Know duration AND substantially impair your ability to live ❑ Yes E Client Refused independently? (Required if question 9 is 'Yes')❑Data not Collected 9b. Do you have documentation of the disability and severity on file? -1 No J] Yes (Required if question 9 is `Yes' 9c. Are you currently receiving services/treatment for this L No -i Client Doesn't Know disability? C Yes Client Refused (Required if question 9 is `Yes') Data not Collected 10. Do you have a physical disability? ❑ Client Doesn't Know 1i No ❑ Client Refused Yes** Data not Collected> 10a. Do you expect this to be of long —continued and indefinite C Client Doesn't Know duration AND substantially impair your ability to live :1 No C Client Refused independently? :i Yes Data not Collected (Required if question 10 is 'Yes')J 10b. Do you have documentation of the disability and severity on file? ❑ No !I Yes (Required if question 10 is `Yes' 10c. Are you currently receiving services/treatment for this El Client Doesn't Know disability? 11 N0 C Client Refused (Required if question 10 is `Yes') ❑Yes E Data not Collected 11. Do you currently have a drug or alcohol problem? ❑ No ❑ Client Doesn't Know ❑Alcohol** ❑ Client Refused Drug** ❑ Data not Collected` E Both** 11 a. Do you expect this to be of long —continued and indefinite :1 Client Doesn't Know duration AND substantially impair your ability to live ❑ No J Client Refused independently? ❑ Yes ❑ Data not Collected (Required if question 11 is `Alcohol', 'Drug', or `Both' 11 b. Do you have documentation of the disability and severity on file? �] No ❑ Yes (Required if question 11 is `Alcohol', 'Drug', or `Both' HMIS Intake and Enrollment Form - General Client Name/ID: 11c. Are you currently receiving services/treatment for this ❑ Client Doesn't Know disability? ] N0 ❑ Client Refused (Required if question 11 is `Alcohol', `Drug', or `Both') Yes ❑ Data not Collected 12. Have you ever been told you have a learning disability or ❑ Client Doesn't Know developmental disability? ❑ No ❑ Client Refused ❑ Yes** ❑ Data not Collected 12a. Do you expect this to be of long —continued and indefinite ❑ Client Doesn't Know duration AND substantially impair your ability to live ❑ No ❑ Client Refused independently? ❑ Yes Data not Collected (Required if question 12 is 'Yes')C 12b. Do you have documentation of the disability and severity on file? ❑ No ❑ Yes (Required if question 12 is `Yes' 12c. Are you currently receiving services/treatment for this ❑ Client Doesn't Know disability? ❑ No ❑ Client Refused (Required if question 12 is `Yes') ❑Yes ❑ Data not Collected 13. Do you feel you currently have a mental health problem? ❑ Client Doesn't Know 1 No ❑ Client Refused ❑'Yes** ❑ Data not Collected 13a. Do you expect this to be of long —continued and indefinite ❑ Client Doesn't Know duration AND substantially impair your ability to live ❑ No ❑ Client Refused independently? ❑ Yes (Required if question 13 is 'Yes')❑Data not Collected 13b. Do you have documentation of the disability and severity on file? ❑ No ❑ Yes (Required if question 13 is `Yes' 13c. Are you currently receiving services/treatment for this ❑ Client Doesn't Know disability? ❑ N0 ❑ Client Refused (Required if question 13 is `Yes') ❑Yes ❑ Data not Collected 14. Have you been a victim of domestic violence or a victim of ❑ No ❑ Client Doesn't Know intimate partner violence? E Yes ❑ Client Refused Data not Collected 14a. How long ago did you have this experience? ❑ Within the past three months (Required if question 14 is `Yes') ❑ Three to six months ago (excluding six months exactly) ❑ From six to twelve months ago (excluding one year exactly) ❑ More than a year ago Client Doesn't Know Client Refused Data not Collected 14b. Are you currently fleeing? ❑ No ❑ Client Doesn't Know (Required if question 14 is `Yes' ❑ Yes ❑ Client Refused 11 Data not Collected HMIS Intake and Enrollment Form - General Client Name/ID: EMPLOYMENT: For adults18 and older or Head of Household < 18 years old, required questions shaded Question Check One Answer Comments 15. Are you currently employed? ❑ No ❑ Client Doesn't Know ❑ Yes ❑ Client Refused 15a. Why are you not employed? ❑ Looking for work (Required if question 15 is `No') ❑ Unable to work ❑ Not looking for work 15b. What type of employment do you have? ❑ Full-time (Required if question 15 is `Yes') ❑ Part-time ❑ Seasonal / sporadic(including day labor Question Check One Answer Comments 16. Are you pregnant? ❑ No ❑ Client Doesn't Know ❑ Yes ❑ Client Refused 16a. What is your due date? (Required if question 16 is `Yes' Question Check One Answer I Comments 17. Did you run away from home or a foster care home? - No ❑ Client Doesn't Know ❑ Yes ❑ Client Refused Question Check One Answer Comments 18. Which branch of the military did you serve in? ❑ Army ❑ Coast Guard ❑ Air Force ❑ Client Doesn't Know ❑;Navy ❑ Client Refused ii Marines ❑ Data not Collected 19. What type of discharge did you receive? ❑ Honorable ❑ General under honorable conditions ❑ Other than honorable conditions (OTH) ❑ Bad Conduct ❑:Dishonorable ❑ Uncharacterized ❑ Client Doesn't Know ❑ Client Refused - ❑ Data not Collected 20. When did you enter military service?' // ❑ Doesn't Know 21. When did you separate from military service? I I ❑ Doesn't Know 22. Household Income as a Percentage of AMI ❑ Less than 30% ❑ 30% to 50% ❑ Greater than 50% HMIS Intake and Enrollment Form - General Client Name/ID: Did you serve in anv of the followina wars/war eras? 23. World War II ❑ No ❑ Client Doesn't Know Dec. 1941— Dec. 1946 ❑ Yes ❑ Client Refused ❑ Data not Collected 24. Korean War ❑ No ❑ Client Doesn't Know Jun. 1950 —Jan. 1955 ❑ Yes ❑ Client Refused ❑ Data not Collected 25. Vietnam War ❑ No ❑ Client Doesn't Know Feb. 1961— May 1975 ❑ Yes ❑ Client Refused ❑ Data not Collected 26. Persian Gulf War (Operation Desert Storm) ❑ No ❑ Client Doesn't Know Aug. 1990 — April 1991 ❑ Yes ❑ Client Refused ❑ Data not Collected 27. Afghanistan (Operation Enduring Freedom) ❑ No ❑ Client Doesn't Know Oct. 2001- Present ❑ Yes ❑ Client Refused ❑ Data not Collected 28. Iraq (Operation Iraqi Freedom) ❑ No ❑ Client Doesn't Know Mar. 2003 —Aug. 2010 ❑ Yes ❑ Client Refused Data not Collected 29. Iraq (Operation New Dawn) ❑ No Client Doesn't Know Sept. 2010 —Dec. 2011 ❑ Yes ❑ Client Refused ❑ Data not Collected 30.Other Peace -keeping Operations or Military ❑ No ❑ Client Doesn't Know Interventions (such as Lebanon, Panama, ❑ Yes ❑ Client Refused Somalia, Bosnia, Kosovo) ❑ Data not Collected Question Check One Answer Comments ASSESSOR ONLY — DO NOT ASK: ❑ No 31. Is the client chronically homeless? ❑ Yes- To be chronically homeless, the client must be homeless individual or a family with an adult head of household (or if there is no adult"ih the family, a minor head of household) with a disability who lives in a- place not meant for human habitation, a safe haven, or in an emergency shelter, and has been homeless continuously for at least 12 months or on at least 4' separate occasions in the last 3 years where the combined occasions equal at least 12 months Question Check One Answer Comments 32. In Permanent Housing? ❑ No ❑ Yes 32a. If yes to previous question, date of move -in: (Required if question 32 is `Yes' I 1 I certify that the information above is correct to the best of my knowledge. Client Signature Site Date RH_v,s e U2 3 2 2016 HMIS Intake and Enrollment Form - General Client Name/ID: Agency Staff Signature Site Date DO NOT WRITE IN BOX BELOW — DATA ENTRY PERSONNEL ONLY (Optional): Date entered into HMIS: / / Question Answer Initials of Staff Comments completion Was the hard copy exit form completely - Yes filled out correctly? ❑ No Staff Name (verifying completion of Data Entry): Revised 3/2/2016 10 GREATER Los ANGELES & ORANGE COUNTY HOMELESS MANAGEMENT INFORMATION SYSTEM (LA/OC HMIS) CONSENT TO SHARE PROTECTED PERSONAL INFORMATION The LA/OC HMMIS is a local electronic database that securely record information (data) about clients accessing housing and homeless services within the Greater Los Angeles and Orange Counties. This organization participates in the HMIS database and shares information with other organizations that use this database. This information is utilized to provide supportive services to you and your household members. What information is shared in the HMIS database? We share both Protected Personal Information (PPI) and general information obtained during your intake and assessment, which rr.ay include but is not limited to: • Your name and your contact information ® Your social security number g Your birthdate ® Your basic demographic information such as gender and race/ethnicity ® Your history of homelessness and housing (including your current housing status, and where and when you have accessed services) a Your self -reported medical history, including any mental health and substance abuse issues Your case notes and services Your case manager's contact information ® Your income sources and amounts; and non -cash benefits ® Your veteran status ® Your disability status ® Your household composition Your emergency contact information ® Any history of domestic violence ® Your photo (optional) How do you benefit from providing your information? The information you provide for the HMIS database helps us coordinate the most effective services for you and your household members. By sharing your information, you may be able to avoid being screened more than once, get faster services, and minimize how many times you tell your `story.' Collecting this information also gives us a better understanding of homelessness and the effectiveness of services in your local area. Who can have access to your information? Organizations that participate in the HMIS database can have access to your data. These organizations may include homeless service providers, housing groups, healthcare providers, and other appropriate service providers. Version 1A Page 1 of 3 Modified 9/23/2015 How is your personal information protected? Your information is protected by the federal HMIS Privacy Standards and is secured by passwords and encryption technology. In addition, each participating organization has signed an agreement to maintain the security and confidentiality cf the information. In some instances, when the participating organization is a health care organization, your information may be protected by the privacy standards of the Health Insurance Portability and Accountability Act (HIPAA). By signing below, you understand and agree that: a You have the right to receive services, even if you do not sign this consent form. a You have the right to receive a copy of this consent form. • Your consent permits any participating organization tc add to or update your information in HMIS, without asking you to sign another consent form. ® This consent is valid for seven (7) years from the date the PPI was created or last changed. ® You may revoke your consent at any time, but your revocation must be provided either in writing cr by completing the Revocation of Consent form. Upon receipt of your revocation, we will remove ycur PPI from the shared HMIS database and prevent further PPI from being added. The PPI that you previously authorized to be shared cannot be entirely removed from the HMIS database and will remain accessible to the limited number of organizations) that provided you with direct services. a The Privacy Notice for the LA/OC HMIS contains more detailed information about how your information may be used and disclosed. A copy of this notice is available upon request. ® No later .han five (5) business days of your written request, we will provide you with: • A correction of inaccurate or incomplete PPI • A copy of your consent form 0 A copy of your HMIS records; and o A current list of participating organizations that have access to your HMIS data. ® Aggregate or statistical data that is released from the HMIS database will not disclose any of your PPI. ® You have the right to file a grievance against any organization whether or not you sign this consent. ® You are not waiving any rights protected under Federal and/or California law. Version 1.1 Page 2 of 3 Modified 912312015 SIGNATURE AND ACKNOWLEDGEMENT Your signature below indicates that you have read (or been read) this client consent form, have received answers to your questions, and you freely consent to have your information, and that of your minor children (if any), entered into the HMIS database. You also consent to share your information with other participating organizations as described in this consent form. ❑ I consent to sharing my photograph. (Check here) Client Name: DOB: Last 4 digits of SS SignaT_ure Cate Head of Household (Check here) Minor Children (if any): Client Name: DOB: Last 4 digits of SS Living with you? (Y/N) Client Name: DOB: Last 4 digits of SS Living with you? (YJN) Client Name: DOB: Last 4 digits of SS Living with you? (Y/N) Print Name of Organization Staff Print Name of Organization Signature of Organization Staff Date Version 1.1 Page 3 of 3 Modified 912312015 Mercy House P.O. Box 1905 Santa Ana, CA 92702 (714)836-7188 (714)867-7901 - fax Disclosure Consent Form Name: Date of birth: If consent is given, it remains in effect for the duration of residency or until the consent is revoked in writing. You will receive a copy of this form once signed. :F�c:c �cx icx x:c icxic:Fx:F:F;F:c icx �cx�cx is is 9c 4c k�c ic;Fx:F x�cx �F �'c�c:F;F �c �c:c 9c is is icx�c:cx:F:F 9c �c �c :F is �cx:F �'cx �c �F k9c �c is Individual to check the appropriate boxes: ❑ I authorize the exchange of information between Mercy House and ❑ I authorize to release (name of agency or individual releasing information) (name of agency or individual releasing information) (specify information) ❑ I authorize Mercy House to release to (name of agency or individual receiving information) Signature to Mercy House. (specify information) Date RELEASE OF INFORMATION AUTHORIZATION: I understand that I am NOT guaranteed this assistance. I understand that at any time it may be necessary for Mercy House to share information or request information from other agencies (public and non-profit) and other sources, but not limited to landlords, service providers, etc. I hereby authorize Mercy House to seek and/or share information relevant to my request for assistance from Mercy House. I further certify under the penalty of perjury that all information I have provided is true and correct, and I have given my permission for verification and understand that the discovery of any false information is grounds for denial or termination of services. Note: This form is signed by the head of household on behalf of all household members. Print Head of Household Name Head of Household Signature Date 'We help people find their way hackhome. P.O. Box 1905 v Santa Ana, CA 92702 v (714) 836-7188 v Fax (714) 836-7901 www.mercyhouse.net Household Obligations & Responsibilities Head of Household Name: Date: A. The Household MUST: 1. Supply any information that your Mercy House case manager determines necessary, including but not limited to evidence of citizenship and/or eligible immigration status. 2. Disclose social security numbers, for ALL household members, sign and submit forms needed to verify income information and submit documents as required for use in regularly scheduled reviews of household income. 3. Participate in all case managers requests, attend all appointments and follow-up with all referrals as recommended. Develop with your case manager a service plan to address housing, benefits education and employment goals. 4. Comply with all provisions of the lease. 5. Give a written 30-day notice to property owner and your case manager before you move or terminate from the Mercy House Program (if applicable). 6. The assisted unit must be the family's only residence. 7. Give your case manager copy of any warning, eviction/3 day pay or quit notice. B. The Household (including each household member) MUST NOT: 1. Commit any serious or repeated violation of the lease 2. Commit fraud, bribery, or any other corrupt or criminal act in connection with the program 3. Participate in illegal alcohol, drug, or violent criminal activity. 4. Sublease or let the unit or assign the lease or transfer the unit. 5. Damage the unit or premises (other than damage from the ordinary wear and tear) or permit any quest to damage the unit or premises. 6. Give Cash to any case manager at any time. CERTIFICATION OF THE FAMILY: I have read and received a copy of this Statement of Household Obligations and Responsibilities. I certify that I am in compliance with all of the Obligations and Responsibilities of the Household, and I acknowledge that my rental assistance may be terminated if I violate one or more of the rules listed above. Note: this form is signed by the head of household on behalf of all household members. Head of household Signature: `We help people find their way backhome. Date: P.O. Box 1905 v Santa Ana, CA 92702 v (714) 836-7188 v Fax (714) 836-7901 www.mercyhouse.net DECLARATION OF ALTERNATE HOUSING ATTEMPTS: Head of House Hold Name: ❑ I certify, under penalty of perjury, that following information is true and complete: (Head of House hold) declare that I would be homeless or will continue to be homeless without this assistance, as no subsequent residence has been identified and I lack the resources and support networks needed to obtain housing. See below a list of the efforts made to obtain a subsequent residence: List efforts & why it is not an option: 1. 2. 3. Head of House hold Signature: Date: Note: this form is signed by the head of household on behalf of all household members. Appendix B TBRA Application HOME Tenant -Based Rental Assistance (TBRA) Program APPLICANT NAME: CURRENT ADDRESS: CITY, STATE, ZIP CODE: HuviE PHONE: EMAIL ADDRESS: APPLICATION ALTERNATE PHONE: HOUSEHOLD COMPOSITION (List the Head of Household and all other members who will be living in the unit. Give the relationship of each family member to the head.) II FULL NAME I RELATIONSHIP I BIRTHDATE I AGE I SEX I SOCIAL SECURITY NO.II HUNTINGTON BEACH RESIDENCY Are you a resident of the city of Huntington Beach: ❑ Yes ❑ No Last permanent address: (Application must include proof of Huntington Beach residency or proof of employment in Huntington Beach) U.S. VETERANS PREFERENCE Are you a U.S. veteran that has been released or discharged under honorable conditions? ❑ Yes ❑ No (Application must include proof of service and honorable discharge paperwork) ELIGIBILITY REQUIREMENTS Eligibility is limited to individuals and families who are currently homeless or residing in a transitional housing facility and meet one of the following conditions (please check the appropriate box and attach documentation verifying status): ❑ Documentation from a Huntington Beach school that the children in the household have been enrolled in and attending the school for at least the last 90 days from the time of admission into the Program. ❑ Documentation from a partner agency, such as the Huntington Beach Police Department, evidencing that the family is known to be homeless in Huntington Beach. ❑ Proof that the applicant's last place of stable residency was in the City of Huntington Beach. Verification from a landlord is acceptable. ❑ Proof that an adult member of the household is working or has been recently hired to work in Huntington Beach. Households must meet at least one of the following criteria or met one of the following criteria prior to entering into a current transitional housing program (Check the appropriate box and attach documentation verifying status): ❑ Sleeping in an emergency shelter; ❑ Sleeping in a place not meant for human habitation. such as, cars, parks, abandoned buildings, streets/sidewalks; ❑ Staying in a hospital or other institution for up to 180 days but was sleeping in an emergency shelter or other place not meant for human habitation (cars, parks, streets, etc.) immediately prior to entry into the hospital or institution; ❑ Victims of domestic violence; and ❑ Those at -risk of homelessness. HOUSEHOLD INCOME AND BENEFITS What is the total gross monthly income of all household members? (Please include wages, salaries and tips, social security, TANF, child support, alimony, regular monetary contributions from family and/or friends, or other benefits). If additional space is needed, please attach separate sheets. NAME GROSS MONTHLY AMOUNT SOURCE OF INCOME (I.E. WAGES, SSI, SSD, TANF, DISABILITY, ANNUITIES, RETIREMENT, CHILD SUPPORT, ETC). ASSET INFORMATION' List the type and Source of any family assets. Provide both the current cash value and the estimated annual income from the asset. NAME TYPE AND SOURCE OF ASSET (BANK ACCOUNTS, INVESTMENTS, ETC.) CASH VALUE OF ASSET ANNUAL INCOME FROM ASSET OTHER SECTION 8 WAITING LISTS ARE YOU CURRENTLY ON A WAITING LIST TO RECEIVE SECTION 8 RENTAL ASSISTANCE (I.E. HOUSING AUTHORITY OF THE COUNTY OF SAN BERNARDINO.. UPLAND HOUSING AUTHORITY, ETC.) ❑ YES ❑ No IF YES, PLEASE LIST WHICH PUBLIC HOUSING AUTHORITY: (NAME) (ADDRESS AND PHONE NUMBER) APPLICATION CERTIFICATION: I/we understand that the above information is being collected to determine if I/we are eligible to receive rental assistance. I/we authorize the Mercy House and the City of Huntington Beach to verify all information provided on this application. HEAD OF HOUSEHOLD SIGNATURE AND DATE SIGNATURE OF ALL OTHER HOUSEHOLD MEMBERS AND DATE SIGNATURE OF ALL OTHER HOUSEHOLD MEMBERS AND DATE SIGNATURE OF ALL OTHER HOUSEHOLD MEMBERS AND DATE SIGNATURE OF ALL OTHER HOUSEHOLD MEMBERS AND DATE SIGNATURE OF ALL OTHER HOUSEHOLD MEMBERS AND DATE Appendix C Declaration of Homelessness DECLARATION OF HOMELESSNESS STATUS Applicant Name: ❑ 1 certify, under penalty of perjury, that following information is true and complete: Applicant Signature: Date: *T=Third Party / O=Observation / S=Self-certification Attach Third Party verification documentation and Intake Observation statements behind this form Verification Type T/O/S*/Notes Situation 1 ❑ An individual or family who lacks a fixed. regular, and adequate nighttime residence, meaning Check one of the following ❑ An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground. (T-not required for emergency shelter or street outreach) ❑ An individual or family living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements (including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs for low-income individuals ❑ An individual who is exiting an institution where he or she resided for 90 days or less AND who resided in an emergency shelter or place not meant for human habitation immediately before entering that institution. (O-not allowed Verification Type T/O/S*/Notes Situation 2 ❑ An individual or family who will imminently lose their primary nighttime residence, provided that: The primary nighttime residence will be lost within 14 days of the date of application for homeless assistance AND No subsequent residence has been identified AND The individual or family lacks the resources or support networks, e.g., family, friends, faith -based or other social networks, needed to obtain other permanent housing Verification Type T/O/S*/Notes Situation 3 - - ❑ Unaccompanied youth under 25 years of age, or families with children and youth, who do not otherwise qualify as homeless under this definition, but who is qualifies as "homeless" under another federal statute AND(Only T is allowed) have not had a lease, ownership interest, or occupancy agreement in permanent housing at any time during the 60 days immediately preceding the date of application for homeless assistance AND O is not allowed) have experienced persistent instability as measured by two moves or more during the 60-day period immediately preceding the date of applying for homeless assistance AND O is not allowed) can be expected to continue in such status for an extended period of time because of chronic disabilities, chronic physical health or mental health conditions, substance addiction, histories of domestic violence or childhood abuse (including neglect), the presence of a child or youth with a disability, OR two or more barriers to employment, which include the lack of a high school degree or General Education Development (GED), illiteracy, law English proficiency, a history of incarceration or detention for criminal activity, and a history of unstable employment, (S is not allowed O is not allowed for barriers to employment) Safety should never be put at risk in order to obtain documentation under this situation. If the provider is a DV Verification Type provider self -certification sufficient. For non -DV providers, if there is no threat of safety supporting verification T/O/S*/Notes should be provided. Situation 4- ❑ Any individual or family who Is fleeing, or is attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life -threatening conditions that relate to violence against the individual or a family member, including a child, that has either taken place within the individual's or family's primary nighttime residence or has made the individual or family afraid to return to their primary nighttime residence AND has no other residence AND lacks the resources or support networks, e.g., family, friends, faith -based or other social networks, to obtain other permanent housing DECLARATION OF HOMELESSNESS STATUS (continued) Applicant Name: Staff Certification I understand that third -party verification is the preferred method of certifying homelessness or risk for homelessness for an individual who is applying for assistance. I understand self declaration is only permittec when I have attempted to but cannot obtain third party verification. Describe in detail efforts made for Third Party verification and attach documentation behind this form (email, phone logs, etc...) Staff Signature: Date: DECLARATION OF AT -RISK OF HOMELESSNESS STATUS Applicant Name: ❑ 1 certify, under penalty of perjury, that following information is true and complete: Applicant Signature: Date: *T=Third Party / O=Observation / S=Self-certification Attach Third Partv verification documentation and Intake Observation statements behind this form Verification Type T/O/S*/Notes Situation 1. ❑ I [and my household] meet the income qualification. (see Computing Part 5 Annual Income form) ❑ I [and my household] do not have the sufficient resources or support network immediately available to prevent me/us from moving to an emergency shelter or another place not designed for or ordinarily used as a regular sleeping accommodation for human beings. S-include supporting documentation when practical Must meet on of the following ❑ I [and my household] have moved because of economic reasons two or more times during the 60 days immediately preceding the application for homelessness prevention assistance -Document moves AND economic reasons. 0-not allowed ❑ I [and my household] am/are living in the home of another because of economic hardship -Document living situation and economic hardship ❑ I [and my household] have been notified in writing that my right to occupy my current housing or living situation will be terminated within 21 days after the date of application for assistance. Only T is allowed ❑ I [and my household] live/lives in a hotel or motel AND the cost of the hotel or motel stay is not paid by charitable organizations or by Federal, State, or local government programs for low-income individuals -Document housing and payment ❑ I [and my household] live/lives in a single -room occupancy or efficiency apartment unit in which there reside more than two persons or live/lives in a larger housing unit in which there reside more than 1.5 persons reside per room, as defined by the U.S. Census Bureau -Document # of rooms and # of individuals ❑ I [and my household] am/are exiting a publicly funded institution, or system of care (such as a health-care facility, a mental health facility, foster care or other youth facility, or correction program or institution); Verification Type T/O/S*/Notes Situation 2 ❑ I am a child or youth who does not qualify as "homeless" under this section, but qualifies as "homeless" under another federal statute. only T is allowed Verification Type T/O/S*/Notes Situation 3 ❑ I am a child or youth who does not qualify as "homeless" under this section, but qualify as "homeless" under section 725(2) of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11434a(2)), and my parent(s) or guardian(s) are living with me. Only T Is allowed Staff Certification I understand that third -party verification is the preferred method of certifying homelessness or risk for homelessness for an individual who is applying for assistance. I understand self declaration is only permitted when I have attempted to but cannot obtain third party verification. Describe in detail efforts made for Third Party verification and attach documentation behind this form (email, phone logs, etc...) Staff Signature: Date: Appendix D Rental Assistance Contract HOME TBRA RENTAL ASSISTANCE CONTRACT LANDLORD NAME & ADDRESS UNIT NO. & ADDRESS TENANT NAME Telephone No. This HOME Rental Assistance Contract ("Contract") is entered into between Mercy House Living Centers ("program administrator') and the Landlord identified above. This Contract applies only to the Tenant family and the dwelling unit identified above. 1. TERNI OF THE CONTRACT The term of this Contract shall beein on and end no later than The Contract automatically terminates on the last day of the term of the Lease. 2. SECURITY DEPOSIT A. Mercy House Living Centers will pay a security deposit to the Landlord in the amount of S The Landlord will hold this security deposit during the period the Tenant occupies the dwelling unit under the Lease. The Landlord shall comply with state and local laws regarding interest payments on security deposits. B. After the Tenant has moved from the dwelling unit, the Landlord may, subject to state and local law, use the security deposit, including any interest on the deposit, as reimbursement for rent or any other amounts payable by the Tenant under the Lease. The Landlord will give the Tenant a written list of all items charged against the security deposit and the amount of each item. .After deducting the amount used as reimbursement to the Landlord. the Landlord shall promptly refund the full amount of the balance to the Mercy House Living Centers. C. The Landlord shall immediately notify the Mercy House Living Centers when the Tenant has moved from the Contract unit. 3. RENT AND AMOUNTS PAYABLE BY TENANT AND NIERCY HOUSE LIVING CENTERS A. Initial Rent. The initial total monthly rent payable to the Landlord for the first twelve months of this Contract is S B. Rent Adjustments. With no less than 30 days' notice to the Tenant and tilercv House Living Centers. the owner may propose a reasonable adjustment to be effective no earlier than the lath month of this Contract. The proposed rent may be rejected by either the Tenant or Mercy House Living Centers. The Tenant may reject the proposed rent by providing the Landlord HOME Rental Assistance Contract (Page Two) with 30 days' written notice of intent to vacate. if Mercy House Living Centers rejects the proposed rent, Mercy House Living Centers must give both the Tenant and the Landlord 30 days' notice of intent to terminate the Contract. C. Tenant Share of the Rent. Initially, and until such time as both the Landlord and the Tenant are notified by Merev House Living Centers. the Tenant's share of the rent shall be S D. 2klLerc'v House Living Center's Share of the Rent. Initially, and until such time as both the Landlord and Tenant are notified by Niercy House Living Centers, Mercy House Living Center's share of the rent shall be S Neither Nlercy House Living Centers, the City of Huntington Beach, nor HUD assumes any obligation for the Tenant's rent, or for payment of any claim by the Owner against the Tenant. Mercy House Livina Center's obligation is limited to making rental payments on behalf of the Tenant in accordance with this Contract. E. Payment Conditions. The right of the owner to receive payments under this Contract shall be subject to compliance with all of the provisions of the Contract. The Landlord shall be paid under this Contract on or about the first day of the month for which the payment is due. The Landlord agrees that the endorsement on the check shall be conclusive evidence that the Landlord received the full amount due for the month, and shall be a certification that: l . The Contract unit is in decent, safe and sanitary condition, and that the Landlord is providing the services, maintenance and utilities agreed to in the Lease,- 2. The Contract unit is leased to and occupied by the Tenant named above in this Contract-, 3. The Landlord has not received and will not receive any payments as rent for the Contract unit other than those identified in this Contract, and 4. To the best of the Landlord's knowledge, the unit is used solely as the Tenant's principal place of residence. h. Overpayments. If Mercy House Living Centers determines that the Landlord is not entitled to any payments received, in addition to other remedies, Nlercy House Living Centers may deduct the amount of the overpayment from anv amounts due the Landlord, including the amounts due under any other Rental Assistance Coupon Contract. 4. HOUSING QUALITY STANDARDS AND LANDLORD -PROVIDED SERVICES A. The Landlord agrees to maintain and operate the Contract unit and related facilities to provide decent, safe and sanitary housing in accordance with 24 CFR Section 882.109, including all of the services, maintenance and utilities agreed to in the Lease. B. Mercy House Living Centers and the City of Huntington Beach shall have the right to inspect the Contract unit and related facilities at least annually, and at such other times as may be necessary to assure that the unit is in decent, safe, and sanitary condition, and that required maintenance, services and utilities are provided. C. if Mercy House Living Centers determines that the Landlord is not meeting these obligations, Mercy House Living Centers shall have the right, even if the Tenant continues in occupancy, to terminate payment of Mercy House Living Center's share of the rent and/or terminate the Contract. 5. TERMINATION OF TENANCY The Landlord may evict the Tenant following applicable state and local laws. The Landlord must give the Tenant at least 30 days' written notice of the termination and notify Mercy House Living Centers in writing when eviction proceedings are begun. This may be done by providing Mercy House Living Centers with a copy of the required notice to the tenant. HOME Rental Assistance Contract (Page Three) 6. FAIR HOUSING REQUIREMENTS A. Nondiscrimination. The Landlord shall not, in the provision of services or in any other manner, discriminate against any person on the grounds of age, race, color, creed, religion, sex, handicap, national origin, or familial status. The obligation of the Landlord to comply with Fair Housing Requirements insures to the benefit of the United States of America, the Department of Housing and Urban Development, and Mcrcy House Living Centers, any of which shall be entitled to involve any of the remedies available by law to redress any breach or to compel compliance by the Landlord. B. Cooperation in Quality Opportunitv Compliance Reviews. The Landlord shall comply with Mercy House Living Centers and with HUD in conducting compliance reviews and complaint investigations pursuant to all applicable civil rights statutes, Executive Orders and all related rules and regulations. 7. NIERCY HOUSE LIVING CENTERS, THE CITY OF HUNTINGTON BEACH, AND HUD ACCESS TO LANDLORD RECORDS A. The Landlord shall provide any information pertinent to this Contract which Mercy House Living Centers, the City of Huntington Beach, or HUD may reasonably require. B. The Landlord shall permit Mercy House Living Centers, the City of Huntington Beach, HUD, or any of their authorized representatives, to have access to the premises and, for the purposes of audit and examination, to have access to any books, documents, papers, and records of the Landlord to the extent necessary to determine compliance with this Contract. 8. RIGHTS OF MERCY HOUSE LIVING CENTERS IF LANDLORD BREACHES THE CONTRACT A. Any of the following shall constitute a breach of the Contract: (I) If the Landlord has violated any obligation under this Contract; or (2) If the Landlord has demonstrated any intention to violate any obligation under this Contract; or (3) If the Landlord has committed any fraud or made any false statement in connection with the Contract, or has committed fraud or made any false statement in connection with any Federal housing assistance program. B. Mercy House's right and remedies under the Contract include recovery of overpayments, termination or reduction of payments. and termination of the Contract. If Mercy House Living Centers determines that a breach has occurred, Mercy House Living Centers may exercise any of its rights or remedies under the Contract. Mercy House Living Centers shall notify the Landlord in writing of such determination, including a brief statement of the reasons for the determination. The notice by Mercy House Living Centers to the landlord may require the Landlord to take corrective action by a time prescribed in the notice. C. Any remedies employed by Mercy House Living Centers in accordance with this Contract shall be effective as provided in a written notice by the Mercy House Living Centers to the Landlord. Mercy House Living Center's exercise or non -exercise of any remedy shall not constitute a waiver of the right to exercise that or any other right or remedy at any time. 31!'a�e HOME Rental Assistance Contract (Page Four) 9. iv1ERCY HOUSE LIVING CENTERS RELATION TO THIRD PARTIES A. Mercy House Living Centers does not assume any responsibility for, or liability to, any person injured as a result of the Landlord's action or failure to act in connection with the implementation of this Contract, or as a result of any other action or failure to act by the Landlord. B. The Landlord is not the agent of Mercy House Living Centers and this Contract does not create or affect any relationship between Mercy House LivinE Centers and any tender to the Landlord, or any suppliers, employees, contractors or subcontractors used by the Landlord in connection with this Contract. C. Nothing in this Contract shall be construed as creating any right of the Tenant or a third party (other than HUD or the City of Huntington Beach) to enforce any provision of this Contract or to asses any claim against HUD, the City of Huntington Beach, Mercy House Living Centers, or the Landlord under this Contract. 10. CONFLICT OF INTEREST PROVISIONS A. No employee of Mercy House Living Centers who formulates policy or influences decisions with respect to the Tenant -Based Rental Assistance Program, and no public official or member of a governing body or state of local legislator who exercise his functions or responsibilities with respect to the program shall have any direct or indirect interest during this person's tenure, or for one year thereafter, in this contract or in any proceeds or benefits arising from the Contract or to any benefits which may arise from it. 11. TRANSFER OF THE CONTRACT The Landlord shall not transfer in any form this Contract without the prior written consent of Mercy House Living Centers. Mercy House Living Centers shall give its consent to a transfer if the transferee agrees in writing (in a form acceptable to Mercy House Living Centers) to comply with all terms and conditions of this Contract. 12. ENTIRE AGREENIENT: INTERPRETATION A. This Contract contains the entire agreement between the Landlord and Nlercy House Living Centers. No changes in this Contract shall be made except in writing signed by both the Landlord and Mercy House Living Centers. B. The Contract shall be interpreted and implemented in accordance with HUD requirements. - - - -- ---- --- -- - ---- --- ----------------------------- -- - -- - - - 4 P rt HOME Rental Assistance Contract (Page Five) 13. WARRANTY OF LEGAL CAPACITY AND CONDITION OF UNIT A. The Landlord warrants the unit is in decent. safe, and sanitary condition as defined in 24 CFR Section 882.109, and that the Landlord has the legal right to lease the dwelling unit covered by this Contract during the Contract term. B. The party, if any, executing this Contract on behalf of the Landlord hereby warrants that authorization has been given by the Landlord to execute it on behalf of the Landlord. Landlord Name (Type or Print): Mercy House Living Centers Representative (Type of Print): (Signature/Date) (Signature/Date) WARNING: 18 U.S.C. 1001 provides, among other things, that whoever knowingly and willingly makes or uses a document or writing containing any false, fictitious, or fraudulent statements or entries, in any matter within the jurisdiction of any department or agency of the United States, shall be fined not more than S10,000, or imprisoned for not more than five years, or both. LANDLORD'S CHECK TO BE MAILED TO: SS NO. NAME(S) ADDRESS SIGNATURE OF OWNER DATE SIGNATURE OF OWNER DATE - - -- ---- -- - ------ -------- -- - ---- -- - -- - - ---- --- ----- - --------- ----- -- - - --- -- - - S�PL_gc 611'ag- Appendix E Landlord Agreement Date: To: (Landlord, Property Manager or Owner) On Behalf of: (Client name) Address: (Client name) has been approved for assistance through the Emergency Solutions Grant (ESG). This program may provide funding for housina relocation and stabilization services and/or short -/medium -term rental assistance to those at risk of becoming homeless or to rapidly re -house those who have become homeless. As part of the assistance. Mercy House will make Financial assistance payments to (Landlord, Property Manager or Owner), on behalf of (Client name). using a corporate check. The payment will be mailed or hand delivered by Mercv House staff to the address noted at the bottom. If at any time during the term of this agreement a notice is given to the program participant to vacate the housing unit, or any complaint used under state or local law to commence an eviction action against (Client name), (Landlord, Propertv Manager or Owner) shall also provide copy of said notice to Mercy House at the address noted at the bottom. Mercv House will make timely payments to (Landlord, Property Manager or Owner) in accordance with the tenant rental agreement information below: Payment Due Date: _ of the month Grace Period: of the month Late Payment Requirements: S ESG assistance will be provided in the following amounts: Tenant will be responsible for the following amounts: Security Deposit Rental for month Rental for month Rental for month Security Deposit Rental for month of Rental for month of Rental for month of The amounts above may represent the entire or partial amount of rent for each month and (Client name) shall be responsible for any balance due. In addition, any late fees or penalties incurred are the sole responsibility of (Client name). If the renter is unable to provide the balance due amount for a particular month, the payment provided by Mercy House for that month shall be returned directly to Mercy House. If the sponsoring agency has paid a security deposit for the renter, these funds shall NOT be returned to Merev House. If: the program participant moves out of the housing unit; the lease terminates and is not renewed, or the program participant becomes ineligible to receive ESG rental assistance then: the rental assistance agreement with the owner must terminate and no further rental assistance payments may be made under that agreement Both; the Merev House and (Landlord, Property Manager or Owner) agree to the terms noted above. Please sign below Agency Representative Signature Landlord, Property Manager or Owner Signature Print name Print name Date Date Mercy House P.O. BOX 41905 Santa Ana, CA 92702 Phone: (714)836-7188 ext: Fax: (714)667-7912 Email: Address check to: Address Line 1: Address Line 2: Phone: Fax: Email: We he(p peop(e find their way 6ackhoine. P.O. Box 1905 v Santa Ana, CA 92702 v (714) 836-7188 v Fax (714) 667-7912 www,mercyhouse.net Appendix F Lease Addendum HOME LEASE ADDENDUM TENANT LANDLORD UNIT NO. & ADDRESS This lease addendum adds the following paragraphs to the Lease between the Tenant and Landlord referred to above. A. Purpose of the Addendum. The lease for the above -referenced unit is being amended to include the provisions of this addendum because the Tenant has been approved to receive rental assistance under the Huntington Beach HOME Rental Assistance Program. Under the Rental Assistance Program, Mercy House Living Centers will make monthly payments to the Landlord on behalf of the Tenant. The Lease has been signed by the parties on the condition that Mercy House Living Centers and Landlord will promptly execute a HOME Rental Assistance Contract. This Lease shall not become effective unless the Contract has been executed by both the Landlord and Mercy House Living Centers, effective the first day of the term of the Lease. B. Conflict with Other Provisions of the Lease. In case of any conflict between the provisions of this Addendum and other sections of the Lease, the provisions of this Addendum shall prevail. C. Terms of the Lease. The term shall begin on and shall continue until: (1) the Lease is terminated by the Landlord in accordance with applicable state and local Tenant/Landlord laws; (2) the Lease is terminated by the Tenant in accordance with the Lease or by mutual agreement during the term of the Lease; or (3) termination of the HOME Rental Assistance Program Contract by Mercy House Living Centers. D. Rental Assistance Payment. Each month Mercy House Living Centers will make a rental assistance payment to the Landlord on behalf of the Tenant. This payment shall be credited by the Landlord toward the monthly rent payable by the Tenant. The balance of the monthly rent shall be paid by the Tenant. E. Security Deposit (1) The (Tenant/Mercy House Living Centers) has deposited $ with the Landlord as a Security Deposit. The Landlord will hold this security deposit during the period the Tenant occupies the dwelling unit under the Lease. The Landlord shall comply with state and local laws regarding interest payments on security deposits. (2) After the Tenant has moved from the dwelling unit, the Landlord may, subject to state and local laws, use the security deposit, including any interest on the deposit, as reimbursement for rent or any other amounts payable by the tenant under the Lease. The Landlord will give the Tenant a written list of all items charged against the security deposit and the amount of each item. After deducting the amount used as reimbursement to the Landlord, the Landlord shall promptly refund the full amount of the balance to the (Tenant/Mercy House Living Centers). F. Utilities and Appliances. The utilities and appliances listed in Column 1 are provided by the Landlord and included in the rent. The utilities and appliances listed in Column 2 below are not included in the rent and are paid separately by the Tenant. UTILITY/APPLIANCE Included in Rent Tenant Paid Garbage Collection Water/Sewer Heating Fuel (specify) Lights, electric Cooking Fuel (specify) Other (specify) Refrigerator Stove/Range G. Household Members. Household members authorized to live in this unit are listed below. The Tenant may not permit other persons to join the Household without notifying Mercy House Living Centers and obtaining the Landlord's permission. Household members: H. Housing Quality Standards. The Landlord shall maintain the dwelling unit, common areas, equipment, facilities and appliances in decent, safe, and sanitary condition (as determined by Section 8 Housing Quality Standards). Termination of Tenancy. The Landlord may evict the Tenant following applicable state and local laws. The landlord must provide the Tenant with at least 30 days' written notice of the termination. The Landlord must notify Mercy House Living Centers in writing when eviction proceedings are begun. This may be done by providing Mercy House Living Centers with a copy of the required notice to the Tenant. J. Prohibited Lease Provision. Any provision of the Lease which falls within the classifications below shall not apply and not be enforced by the Landlord. (1) Confession of Judgment. Consent by the Tenant to be sued, to admit guilt, or to a judgment in favor of the landlord in a lawsuit brought in connection with the Lease. (2) Treatment of Property. Agreement by the Tenant that the Landlord may take or hold the Tenant's property, or may sell such property without notice to the Tenant and a court decision on the rights of the parties. (3) Excusing the Landlord from Responsibility. Agreement by the Tenant not to hold the Landlord or Landlord's agent legally responsible for any action or failure to act, whether intentional or negligent. (4) Waiver of Legal Notice. Agreement by the Tenant that the Landlord may institute a lawsuit without notice to the Tenant. (5) Waiver of Court Proceedings for Eviction. Agreement by the Tenant that the Landlord may evict the Tenant Family (j) without instituting a civil court proceedings in which the Family has the opportunity to present a defense, or (ii) before a decision by the court on the rights of the parties. (6) Waiver of Jury Trial. Authorization to the Landlord to waive the Tenant's right to a trial by jury. (7) Waiver of Right to Appeal Court Decision. Authorization to the Landlord to waive the Tenant's right to appeal a court decision or waive the Tenant's right to sue to prevent a judgment from being put into effect. (8) Tenant Chargeable with Cost of Legal Actions Regardless of Outcome of the Lawsuit. Agreement by the Tenant to pay lawyer's fees or other legal costs whenever the Landlord decides to sue, whether or not the Tenant wins. K. Nondiscrimination. The Landlord shall not discriminate against the Tenant in the provision of services, or in any other manner, on the grounds of age, race, color, creed, religion, sex, handicap, national origin, or familial status. TENANT SIGNATURES LANDLORD SIGNATURES By: (Type or Print Name of Tenant Representative) LANDLORD NAME: (Signature/Date) By: (Type or Print Name of Landlord Representative) By: (Type or Print Name of Tenant Representative) (Signature/Date) (Signature/Date) Appendix G Rent Reasonableness Standard RENT REASONABLENESS AND FAIR MARKET RENT CERTIFICATION Proposed Unit Unit #1 Unit #2 Address Number of Bedrooms Square Feet Type of Unit/Construction Housing Condition/Quality Location/Accessibility Amenities Unit: Site: Neighborhood: Age in Years Utilities (type) Unit Rent Utility Allowance Gross Rent Handicap Accessible? CERTIFICATION: A. Rent Proposed Contract Rent + Utility Allowance= Proposed Gross Rent Two comparable units must be identified in order to certify Rent Reasonableness. Find listings for comparable units online (on Craigslist or a similar site). ** Print out the listings and attach them in back pocket of folder as proof. B. Compliance with Rent Reasonableness Rent [] is [] is not reasonable in comparison to rent for other comparable unassisted units. C. Compliance with Fair Market Rents Rent [] does [] does not exceed applicable Fair Market Rent of S *County agreed to go over Fair Market Rent Rates for 2016 Maw, 3�ar�e Space i rend HUD OC Standards $953 (2016) OC Central Standards $953 (select Cities)' (2016) �InGie ; Ocupay E Eff,c'enc. tl-edroc�nt 2 Bedr oar roi nedroc,a �501 $839 $1,161 1 $1,324 $1,672 $2,327 $2,532 i $839 OC Restricted payment Standards (for selected citieslreasonable $881 $839 accommodations) * (2016) $9,999 j $9,370 61,645 bz,390 i 62,509 j $1,119 $1,515 $1,780 $2,460 1 $2,509 * CENTRAL PAYMENT STANDARDS: COSTA MESA, FOUNTAIN VALLEY, HUNTINGTON BEACH AND YORBA LINDA. *RESTRICTED PAYMENT STANDARDS: THE FOLLOWING "HIGH RENT AREAS' OF THE COUNTY TO QUALIFY FOR RESTRICTED PAYMENT STANDARDS: ALISO VIEJO, DANA POINT, IRVINE, LAGUNA BEACH, LAGUNA HILLS, LAGUNA NIGUEL, LAKE FOREST, MISSION VIEJO, NEWPORT BEACH, RANCHO SANTA MARGARITA, SAN JUAN CAPISTRANO, SAN CLEMENTE, TUSTIN, AND UNINCORPORATED AREAS SOUTH OF THE 55 FREEWAY. Name:7 Signature: Date: Appendix H Orange County Housing Authority Utility Allowance Schedule O P. a N 1:3 E r_ +_i 11 'i- Y Community Resources O i,' t cr-IT,,in It y. (7ur Cnr•; .n ORANGE COUNTY HOUSING AUTHORITY UTILITY ALLOWANCE SCHEDULE HOUSING CHOICE VOUCHER PROGRAM Effective Date: November 1, 2015 Bedroom: 0 1 2 .3 4 5+ GAS Cooking 2 7 7 j....... 10 12 17 Heating 12 15 19 28 34 35 W. Heater 7 9 9 15 19 21 ELECTRIC �' Basic 13 19 23 1 40 40 40 Cooking 5 ...-- 8 9 13 18 20 ;--- Heating20 11 15 26 33 37 W. Heater 15 21 27 36 37 37 OTHER Water 16 19 23 32 38 43 Trash/Sewer 23 23 23 23 23 23 Refrigerator ! 9 9 9 9 9 9 Stove 7 7 7 7 7 7 Mobile Home 62 62 62 62 62 62 ORANGE CO _ -Y HOUSIN1- A_ T HORIT 1770 NORTH BROADWAY, SANTA ANAL CA 92706-2642 • PHONE (714) 480-2700 Appendix I Case Management and Self Sufficiency Program Policies and Procedures Intake Process A. Referrals Mercy House Case Management Policies 1. Referrals accepted from any source — preference will be given to referrals received from Huntington Beach Police Officers or other City Departments. 2. All Mercy House Programs offer services on a nondiscriminatory basis and ensure that all citizens have B. Waiting List C. Intake access to information regarding the services provided through our programs. Mercy House does not discriminate on the basis of race, color, age, gender, disability, religion, national origin or sexual orientation. In the case of disability Mercy 1-louse will make every reasonable accommodation to meet the needs of the client. Mercy House does not discriminate based on religious affiliation or preference. Mercy House also prohibits coercive religious activities. 1. Program Manager (PM/CM) manages waiting list 2. Waiting list is closed at 20, or as determined by PM/CM 1. When there is an opening, PM/CM contacts the next individual on the waiting list. 2. PM/CM informs client of necessary documentation required to complete process. 3. PM/CM conducts in -person intake and reviews the T13RA program guidelines 4. PM/CM must be able to verify housing status or homeless status per HUD standards prior to service/entry and connection to the City of Huntington Beach. 5. If an eligible client is a close friend or relative of the Case Manager, that client must be referred to another Case Manager. 6. If accepted, schedule case management appointment. 7. If not accepted or ineligible, inform referral of reason why. Note reason on top of first page of intake packet and dead file packet in binder. Mercy House Case Management Policies 8. PM/CM updates status column of waiting list after contact/ attempted contact with referral is made so other staff are aware of status II. Case Management A. Program Manager Schedule 1. PM/CM to complete schedule and update as needed. Schedule is posted in homes and given to client and includes: a. All cm meetings b. Location of meetings (i.e. office, apt) c. PM/CM work schedule (so residents are aware of staff availability) B. Case Management Meetings 1. Case management is held at least monthly 2. Tasks reviewed regularly include: a. finances b. housing and other goals c. employment or job training issues d. volunteering issues (Disabled only) e. resident/staff issues or concerns f. program status: determine continued eligibility C. Program Extension Policy 1. At least twice a year, staff will complete an intake recertification to ensure clients remain eligible 2. Clients who are ineligible will create a plan with their CM to exit the household from the program 3. Though case management and compliance is not a requirement to enter the program, clients who refuse to participate may not be recertified to continue receiving assistance. 2 Mercy House Case Management Policies D. Exiting a Resident 1. PM/CM should begin discussing exit planning immediately after entrance into program 2. PM/CM continually works with resident to prepare for exit 3. For scheduled exits: a. PM/CM begins formal transition with resident at least one month prior to scheduled exit date 1. give resident Exit packet 2. provide resident referrals for housing and assistance programs 3. assist residents with locating housing and completing necessary paperwork 4. For unscheduled exits: a. I'M/CM should issue exits with sensitivity b. I'M/CM should bring resident into the office or a private location. PM/CM may ask a co-worker to sit in on an exit. c. PM/CM assists to make transition as smooth as possible for exiting resident and other residents d. I'M/CM has discretion as to the length of time to give resident to move 1. exception = in cases where resident poses a threat to others, he/she must move out immediately 5. PM/CM to complete a Program evaluation before exiting. E. Closing Case Files 1. Case files to be closed within 30 days of exit 2. Review all forms for completion (file will be returned if forms are incomplete) 3. Write resident name, entry and exit dates and exit status (successful, unsuccessful or neutral) on folder tab 4. If resident did not complete an exit evaluation, write no evaluation on the outside of folder 5. Submit closed file to you Direct Supervisor. 6. Supervisor audits file and initials 7. File returned to PM/CM to archive file in a secured location 3 Mercy House Case Management Policies III. Documentation A. Case Management Files 1. All documentation maintained and secured in case files — no loose documents 2. Case Management Databases should be updated at least monthly 3. Organize case file as outlined in Case File Review form 4. All case files must be kept in a locked file cabinet 5. Never use white out! If you make an error put a line through it and make the correction. 6. All signatures must be in blue ink and the original form should be in the case file. If client send you a form electronically that requires their signature note that in the case file and secure original at the next case management meeting 7. All case management information must be kept confidential and information should not be disclosed to anyone outside the Mercy House staff without a signed disclosure form 8. All client's personal information should be protected and only shared even among Mercy House staff when necessary to ensure the client receives quality assistance 9. All meetings need to be documented in case notes and include: a. date of meeting b. overview of meeting content c. observations/concerns d. staff initials 10. All Supportive Services provided for Client should be clearly documented in Case File. If gift cards, bus passes, or other vouchers are issued they must be listed on Service Sheet in file with client's signature verifying that they received the assistance. A copy of the voucher/card should also be placed in case file. All cards and vouchers issued should also be logged and recorded in accordance with our Gift Card Policy. In the case of FRP or RR if it is necessary for cards to be distributed off site a second staff signature if required. 4 Mercy House Case Management Policies 11. Case Management meetings should be face to face. If you are unable to meet with the client and connect with them over the phone please note the reason in the case file 12. Case notes should clearly connect to the clients stated housing and other goals IV. Audits A. Case File Reviews 1. Purpose = promote consistency between programs, ensure documents are implemented, prepare for external audits 2. Reviews conducted on a monthly basis or as needed by PD 3. Case files are selected by Supervisor each month for review 4. Once reviewed, staff will receive completed case file review form noting follow-up needed. PM/CM is responsible for correcting and returning completed file review form to Supervisor by date stated on review. B. Voucher / Gift Card Review 1. Program Director will review all Voucher/Gift Card Logs to ensure the amount of cards purchased / distributed match the documentation on a monthly basis. 2. Periodic spot checks will be made to compare the log to individual case files. V. Tracking and Aftercare Programs A. Tracking Program 1. All residents eligible for tracking program 2. Residents must consent to tracking on Exit Interview 3. If consent is obtained, Aftercare Specialist will report progress to PM/CM's at 6 months and 1 year after exit to obtain info on Program Evaluation 4. Aftercare Specialist monitors tracking program and informs PM/CM when contact needs to be initiated 5. Info obtained will be submitted in database. Info will be used to determine long-term success/failure rates. 5 Mercy House Case Management Policies VI. Reports A. Resident HMIS Database 1. Report provides program and statistical info on residents 2. Report to be updated monthly by PM/CM with updated information on all residents VII. Resources (List of Resources can be accessed on Server) A. Resident/Staff Resources 1. Mercy House Center — emergency services 2. Public Law Center — legal services 3. Legal Aid Society — legal services 4. Mariposa Counseling Center 5. Trinity Counseling Center 6. Rainbow Directory 7. Staff Resource Directory 8. Resident Resource Directory 9. Housing Directory VIII. Internal Meetings A. Program Team Meetings 1. 2„ a Monday of each month attended by program staff 2. Staff present cases and receive feedback and support 3. Staff gives update on their program B. Staff Meetings 1. General Meetings quarterly 2. Trainings scheduled as needed IX. Miscellaneous Policies A. Emergency Procedures (see attached Emergency Response Plans for each site) In the case of a Medical Emergency: 0 Mercy House Case Management Policies 1. Observe the situation if the individual is in need of medical assistance and cannot or should not transport him or herself to the doctor's office call 911. 2. Copy the medical information sheet in the resident's case file and have it ready for the paramedics. 3. Write up an incident report and submit it to the ED. 4. Log incident in the Daily log and case file. B. Child Abuse Reporting Procedures 1. Policy a. staff informed of mandated reporter status and what qualifies as abuse upon hire b. residents informed of mandatory reporting under the heading of Childcare in our Resident Handbook 2. Who Reports? a. when an incident is suspected/observed by staff or volunteers the PM/CM will report the incident or the PM/CM will direct the appropriate staff member to report b. when an incident is suspected/observed by a licensed or pre -licensed therapist or social worker he/she is responsible to report the incident 3. If Abuse/Neglect is suspected a. call CPS to see if incident is reportable — (714)940-1000 b. if CPS deems the incident reportable, complete a written report (forms on file at Shelter) c. complete report except for name/title and signature in box B d. remove our copy from report (yellow copy) and file in the Child Abuse Reports binder e. complete name/title and sign report f. submit report within 36 hours 4. Maintaining Written Reports a. written reports will be kept in a binder labeled Child Abuse Reports b. the Child Abuse Reports binder will be kept in a secure location in the office 7 Mercy House Case Management Policies c. reports will be filed in the case file once the resident exits Mercy House 5. Reporting Child Abuse Reports to Staff a. when a report is made the PM/CM will report at the Case Management Meeting following the report that "a child abuse report was filed against...". It is not necessary to disclose who filed the report. b. information surrounding the report will be shared with staff c. information will also be shared at staff meetings at the PM/CM's discretion Exhibit B Documentation, Recordkeeping, Reporting and Monitoring Requirements Documentation, Recordkeeping, Reporting and Monitoring Requirements Mercy House (Subrecipient) shall comply with the requirements set forth in this document at all times during the term of the HOME Subrecipient Agreement (Agreement) between the City of Huntington Beach (City) and Subrecipient, to which this document is attached. I. Documentation and Recordkeeping A. Records to be Maintained Subrecipient shall maintain all records required by the federal regulations specified in 24 CFR 92.508(a)(3), which are pertinent to the Services to be funded under the Agreement. Records shall be maintained for each prospective participant, each Eligible Household and each Housing Unit inspected and/or occupied by an Eligible Household pursuant to the Agreement. Such records shall include but are not limited to: ■ Records providing a full description of each activity undertaken. ■ Records required to determine the eligibility of activities for use of HOME funds. ■ Records (including property inspection reports) demonstrating that each Housing Unit occupied by an Eligible Household meets the property standards of 24 CFR 92.251(d) and 24 CFR 982.401 upon occupancy and at the time of each annual inspection. ■ Records demonstrating compliance with the property standards and financial reviews and actions pursuant to 24 CFR §92.504(d). ■ Records demonstrating that each Eligible Household is income eligible in accordance with 24 CFR 92.203, including all TBRA applications, eligibility determinations and documentation regarding any appeals of eligibility determinations. ■ Records demonstrating that Subrecipient is in compliance with the City's written tenant selection policies and criteria of 24 CFR 92.209(c), including any targeting provisions of 24 CFR 92.209(h), and calculation of each Subsidy Payment. ■ Records demonstrating that each rental agreement for an Eligible Household receiving Subsidy Payments complies with the tenant and participant protections of 24 CFR 92.253. ■ Records documenting compliance with Subrecipients marketing and outreach obligations under the Agreement, including compliance with the fair housing and equal opportunity components of the HOME program and HUD's Affirmative Fair Housing and Marketing regulations and the City's Affirmative Fair Housing Marketing Plan, when adopted. ■ Records documenting compliance with the lead -based hazards requirements under the Agreement, the HOME Program, and 24 CFR Part 35, subparts A, B, J, K, M and R. ■ Financial records as required by 24 CFR §92.508(a)(5) and 24 CFR §92.222. ■ Records documenting the HOME Matching Contributions made by Subrecipient pursuant to the Agreement and the HOME Program, specifically including 24 CFR 92.218 through 24 CFR 92.222. B. Retention The Subrecipient shall retain all financial records, supporting documents, statistical records, and all other records pertinent to the Agreement for a period of five years after the period of Subsidy Payments terminates. Notwithstanding the above, if there are litigation matters, claims, audits, negotiations or other actions that involve any of the records cited and that have started before the expiration of the five-year period, then all pertinent records must be retained until completion of the actions and resolution of all issues, or the expiration of the five-year period, whichever occurs later. C. Client Data The Subrecipient shall maintain client data demonstrating client eligibility for services provided. Such data shall include, but not be limited to, client name, address, income level or other basis for determining eligibility, and description of service provided. Such information shall be made available to City monitors or their designees for review upon request. D. Disclosure The Subrecipient understands that client 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 Subrecipient's responsibilities with respect to Services provided under this Agreement, is prohibited unless written consent is obtained from such person receiving services and, in case of a minor, that of a responsible parent/guardian. E. Close Outs The Subrecipient's obligation to the City shall not end until all close-out requirements are completed. Activities during the 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), and determining the custodianship of records. Notwithstanding the foregoing, the terms of this Agreement shall remain in effect during any period that the Subrecipient has control over HOME funds, including program income. F. Audits and Inspections All Subrecipient records with respect to any matters covered by this Agreement shall be made available to the City, HUD and the Comptroller General of the United States Or any of their authorized representatives, at any time during normal business hours, as often as deemed necessary, to audit, examine, and make excerpts or transcripts of all relevant data. Any deficiencies noted in audit reports must be fully cleared by the Subrecipient within 30 days after receipt by the Subrecipient. Failure of the Subrecipient to comply with the above audit requirements will constitute a violation of the Agreement and may result in the withholding of future payments. The Subrecipient hereby agrees to have an annual agency audit conducted in accordance with current City policy concerning Subrecipient audits and OMB CircularA-122. II. Quarterly Progress Reports Subrecipient shall submit quarterly progress reports to the City in a form approved or directed by the City on or before each April 15, July 15, October 15 and January 15, which shall include all of the following information regarding Subrecipient's activities during the prior quarter: ■ The number of TBRA applications received, processed, approved and disapproved. ■ The number of Housing Units inspected, approved and disapproved and a description of any corrective work performed by Landlords to comply with HQS. ■ The number of Eligible Households assisted, including specific information regarding the number of and ages of all household members, income categories, types and amounts of assistance provided to each Eligible Household, and remaining terms of assistance expected to be provided to such households. ■ Description of each Eligible Household's participation in required self-sufficiency program and other optional social and supportive Services provided or otherwise made available to each Eligible Household. ■ Budget reconciliation information, including year-to-date expenditures and remaining balance available for Subsidy Payments in accordance with the Budget and the Agreement. ■ Number of additional Eligible Households Subrecipient expects to qualify and assist within the following three-month period. ■ Updated schedule of performance of the Services under the Agreement, including a schedule for qualifying and assisting additional Eligible Households as permitted by the Budget. ■ Information regarding any complaints receipted from Applicants or Eligible Households and any correspondence received from community members or organizations or other nonprofit organizations regarding the Program or specific activities or individuals involved in the Program. ■ Documentation of the HOME Matching Contributions made by Subrecipient pursuant to the Agreement and the HOME Program, specifically including 24 CFR 92.218 through 24 CFR 92.222. III. Performance Monitoring A. Monthly Reports Subrecipient shall provide progress reports on a Monthly basis during the first quarter of the Term of the Agreement in order for the City to review Subrecipient's activities and progress under the Agreement and to ensure that the Program is progressing smoothly. B. City Oversight and Review City will monitor the performance of the Subrecipient against the goals and performance standards set forth in the Agreement. From time to time, City shall be entitled to audit and review Subrecipient's performance of the Services in accordance with the terms of the Agreement and compliance with the HOME Program. Substandard performance as determined by the City will constitute noncompliance with the Agreement. If action to correct such substandard performance is not taken by the Subrecipient within a reasonable period of time after being notified by the City, termination procedures will be initiated in accordance with Section 8.3 of the Agreement. Exhibit C Gross Income Calculation Form Income Calculation Worksheet Semi -Monthly pay cycles are usually 15 days or longer from the 1 st - 15th and the 16th - 30th/31 st Semi -Monthly salaried wage stubs will often show 86.66 or 86.67 under the "hours" section Bi-Weekly pay cycles are usually 14 days and begin on the same day of the week and end on the same day of the week from pay cycle to pay cycle For migrant workers; monthly gross income is coputed by averaging the total gross income received during the previous 12 months and is NOT recalculated until the next annual certification Select Appropriate Income Pay Cycle for Applicant Household Weekly: (52 pay periods annually) Member Name: $ + $ + $ _ $ / 3 = $ Weekly Average $ X 52 pay periods $ gross annual income Member Name: $ + $ + $ _ $ 3 = $ Weekly Average $ X 52 pay periods $ gross annual income Bi-Weekly: (26 pay periods annually) Member Name: $ + $ + $ _ $ 3 = $ Bi-Weekly Average $ X 26 pay periods $ gross annual income Member Name: $ + $ + $ _ $ 3 = $ Bi-Weekly Average $ X 26 pay periods $ gross annual income Semi -Monthly: (24 pay peroids annually) Member Name: $ + $ + $ _ $ 3 = $ Semi -Monthly Avg. $ X 24 pay periods $ gross annual income Member Name: $ + $ + $ _ $ 3 = $ Semi -Monthly Avg. $ X 24 pay periods $ gross annual income Monthly: (12 pay periods annually) Member Name: $ X 12 pay periods $ gross annual income Member Name: $ X 12 pay periods $ gross annual income Fluctuating: use for seasonal, migrant, agricultural, commissions Member Name: $ gross annual income Member Name: $ gross annual income Total Household Annual Income From All Sources Listed Above: © MDG Associates Inc. - 2012 Exhibit D Household Budget Worksheet Monthly Budget Net Income: Employment Other: Food Stamps Total: Expenses: Rent Gas Electric Cable Phone Food Car Insurance Gasoline Medical Recreation Savings Hygiene Other: Total: Notes: I have read the duties of a client for the TBRA program and certify that I will comply and adhere to this budget that has been set. Resident's Name - Please Print Resident's Signature Other Household Member Member's Signature Date Date Exhibit E Lead -Based Hazard Information Pamphlet "Protect Your Family from Lead in your Home" Lead -Based Paint Inspection Form TENANT NAME: OWNER NAME: UNIT ADDRESS: OWNER #: CITY: OWNER PHONE: () - TELEPHONE #: () - 1. UNIT BUILT PRIOR TO 1978? (If NO, Go to #6) ❑ YES ❑ NO 2. CHILDREN IN UNIT UNDER AGE SIX? (If NO, Go to #6) ❑ YES ❑ NO 2A. CHILDREN UNDER AGE SIX WITH IDENTIFIED EBL? ❑ YES ❑ NO NOTE: If there are no children under the age of six, with identified "Elevated Blood Levels (EBL's)", unit requires neither testing, nor abatement, for lead -based paint. If, however, there are children under the age of six years residing in the unit, you must inspect for defective paint surfaces. If children under the age of six, with identified EBL's are residing in the unit, the unit must also be tested for lead -based paint. (See number 5, below). Interior- All deteriorated painted surfaces less than 2 sq. ft. or less than 10% of the component, only stabilization is required. Clearance testing is not required. Exterior- All deteriorated paint surfaces more than 20 sq. ft. on exterior surfaces must be stabilized in accordance with all safe work practice requirements. 3. Defective paint surfaces: Inspect all interior and exterior surfaces, walls, stairs, deck, porch, railing, windows, doors and any "chewable" surface. CHIPPING ❑ YES ❑ NO SCALING ❑ YES ❑ NO CRACKING ❑ YES ❑ NO PEELING ❑ YES ❑ NO LOOSE ❑ YES ❑ NO OTHER ❑ YES ❑ NO 4. UNIT REQUIRES CORRECTION OF DEFECTIVE PAINT SURFACES: ❑ YES ❑ NO 5. UNIT REFERRED FOR TESTING TO: 6. A. NEW LEASE: LEAD -BASED PAINT HAZARDS PRESENT ❑ YES ❑ NO B. RENEWAL: ❑ UNIT PASSED ❑ OWNER TO CORRECT ALL DEFECTIVE SURFACES ❑ INCONCLUSIVE; TESTING OF PAINT SURFACES REQUIRED ❑ UNIT FAILED; PHA TO TRANSFER TENANT COMMENTS: Mercy House Staff DATE Subsidy No. Date Inspected Pass ❑ Fail ❑ 'Lead -eased P—t Insp.—I Fo do 03-2 OTT Exhibit F Budget EXHIBIT F TBRA PROGRAM BUDGET HUNTINGTON BEACH, CALIFORNIA Year 1 Year 2 Total Contract I. HOME Funds Tenant -Based Rental Assistance Subsidy 1 $174,336.00 $174,336.00 $348,672.00 Security Deposits Subsidy' $12,257.44 $12,257.44 $24,514.88 Utility Depsoits Subsidy 3 $2,020.56 $2,020.56 $4,041.12 Administrative Costs HQS Inspections 4 $3,400.00 $3,400.00 $6,800.00 Income Eligiblity 5 $2,550.00 $2,550.00 $5,100.00 Total Administrative Costs $5,950.00 $5,950.00 $11,900.00 Total HOME Funds $194,564.00 $194,564.00 $389,128.00 II. City Inclusionary Funds & LMIAF 6 $46,000.00 $46,000.00 $92,000.00 III. Total City Contract $240,564.00 $240,564.00 $481,128.00 IV. Other Mercy House Funding Sources' $0.00 $0.00 $0.00 V. Total TBRA Program Budget $240,564.00 $240,564.00 $481,128.00 1 Approximately _17_ Eligible Households can receive assistance for 6 to 12 months per year. z Approximately _17_ Eligible Households can receive assistance per year. 3 Approximately _17_ Eligible Households can receive assistance per year. 4 Assumes 34 inspections per year at 100 per inspection. Assumes inspections every six months for each Eligible Household and some households will need more than one inspection before move -in. Average of 16 hours per Housing Unit. Activities will include inspection advocacy with landlord, agreemetns with landlord, inspection onsite, travel time, review and approval, and follow up. 5 Assumes 34 screenings per year at $75 per screening. Assumes income eligibility screenings every six months for each adult and some households will have more than one adult. Average of 6 hours per adult with income. Activities will include income documentation screening, verification and review, calcualtion of gross, adjusted, exclusions, advocacy with client on income, and follow up. 6 Includes ineligible administrative costs under the HOME Program, such as Intake Assessment, Housing Search, Case Management, Self -Sufficiency, related Support Services, and Overhead. ' Includes ineligible administrative costs under the HOME Program, such as Intake Assessment, Housing Search, Case Management, Self -Sufficiency, related Support Services, and Overhead that will be Tuned with other funding sources available to Mercy House. Exhibit G Housing Quality Standards (HQS) Inspection Checklist Attachment F Inspection Checklist U.S. Department of Housing OMB Approval No. 2577-0169 and Urban Development (exp. 4/30/2014) Housing Choice Voucher Program Office of Public and Indian Housing Public reporting burden for this collection of information is estimated to average 0.50 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed. and completing and reviewing the collection of information. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection. This collection of information is authorized under Section 8 of the U.S. Housing Act of 1937 (42 U.S.0 1437f). The information is used to determine if a unit meets the housing quality standards of the section 8 rental assistance program. Privacy Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form by Section 8 of the U S Housing Act of 1937 (42 U S C 1437f). Collection of the name and address of both family and the owner is mandatory The information is used to determine if a unit meets the housing quality standards of the Section 8 rental assistance program. HUD may disclose this information to Federal, State and local agencies when relevant to civil, criminal. or regulatory investigations and prosecutions. It will not be otherwise disclosed or released outside of HUD, except as permitted or required by law. Failure to provide any of the information may result in delay or rejection of family participation Name of Family Tenant ID Number iDate of Request (mm/ddlyyyy) Inspector ------------------------- Tyne of Inspecacn Neighborhood/Census Tract Date of Inspection (min/dd/yyyy) A. General Information -- ------------------- - - -------- ---- ------ - Inspected Unit -------- _" --- -- Year Constructed IYYYYI__________-__ Full Adcress (including Street, City, County, State, Zip) Number of Children in Family Under 6 Owner Name of Owner or Agent Authorized to Lease Unit Inspected !Phone Number Owner: Owner: Agent Agent_ - Address of Owner or Agent Owner: , Agent: , Date of Last Inspection (mm/ddlyyyy) 'PHA Housing Type (check as appropriate) Ll High Rise i EJ Low Rise 3,4 stories EJ Mobile Home Row House/Garden/Townhous Semi Detached Duplex Shared Housing - Single Family Detached ---- �i Single Room Occupancy i I B.-Summa_ry_Decision On Unit -Jo be completed after form_has been filled Pass Number of Bedrooms for Purposes of Number of Sleeping Rooms Fail the FMR or Payment Standard InconclusiveI Inspection Checklist Item Yes No m- Final Approval No. 1. Living Room Pass Fad 'Conc., Comment Date(mm/dd/yyyy) 1.1 Living Room Present X 1.2 Electricity X 1.3 --.-...-- - --- Electrical Hazards X ? --- — -.. ! 1.4 Security 1.5 Window Condition X 1.6 Ceiling Condition-__- 1 7 Wall Condition v 1.8 Floor Condition X ' Room Codes 1 = Bedroom or Any Other Room Used for Sleeping (regardless of type of room); 2 = Dining Room or Dining Area, 3 = Second Living Room, Family Room, Den, Playroom, TV Room, 4 = Entrance Halls, Corridors, Halls, Staircases; 5 = Additional Bathroom; 6 = Other HAPPY Software, Inc Page 1 of 7 form HUD-52580 (3/2001) ref Handbook 7420.8 Item Yes No In- Final Approval No. 1. Living Room (Continued) Pass Fail Conc.; Comment ! Date (mm/dd/yyy)) 1.9 Lead -Based Paint X Not Applicable A II t d rf f e f deteriorat d I --- re a pain e su aces r e o e paint? If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component? 2. Kitchen -- -- --- - - .. - - ----- ---- --- - ._.... ...... 2 1 .. -- --- ---------------- Kitchen Area Present X i 2.2 Electricity X -- -- -- ---------- V 2 3 Electrical Hazards 2.4 Security I X T------------- 2.5 Window Condition ---' =----------- 2.6 Ceding Condition X -- -- 2.7 Wall Condition --- X --------------------------------- 2.8 Floor Condition ^ --- - - --- _ - -- --- --- -- - - -- - - - 2 9 ------- ------- ---- Lead -Based Paint -"v-- -- Not Applicabie Are all painted surfaces free of deteriorated paint? i If not, do deteriorated surfaces exceed two j square feet per room and/or is more than j 0% of a component? 2.10 Stove or Range with Over X i 2,11 Refrigerator � X I ------------ -- - 2.12 Sink X 2.13 Space for Storage, Preparation, and Serving of Food j 3. Bathroom F 3A Bathroom Present - - - 3.2 Electricity X 3 3 Electrical Hazards X - --" - - - -_ - — — —- -- 3.4 Security I X 3.5 Window Condition X - 3.6 Ceiling Condition X 3.7 Condition X 3.8 -Wall Floor Condition X 3 9 Lead -Based Paint Not Applicabie Are all painted surfaces free of deteriorated -- paint? i If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component? 3.10 Flush Toilet in Enclosed Room in Unit X j 3.11 Fixed Wash Basin or Lavatory in Unit X 3 12 Tub or Shower in Unit X 313 Ventilation X j HAPPY Software, Inc Page 2 of 7 form HUD-52580 (312001) ref Handbook 7420.8 Item 4. Other Rooms Used For Living and Hails Yes No I In- Final Approval ' No, Pass I Fail Conc,: Comment _— Date (mm/dd/yyyy) 4 1 Room Type Room Location Floor Level 42 - - Electricity/Illumination - - - - -- r- --- -- ---- -- 4.3 Electrical Hazards - - - -- - i ' - --- - --- ------------ - -- - -- ------ 4.4 Security 4 5 Window Condition - -- - - ........ ---- - - - - --.....--' T - ---- ------------ - -- --- --- 4 6 Ceiling Condition 4-7 Wall Condition i i 48 Floor Condition 4.9 Lead -Based Paint j Not Applicable Are all painted surfaces free of deteriorated ---- paint? If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a componenY� =--------- --------------- --------------- - �- --------------- -- ----------- 4.10 Smoke Detectors 4 1 Room Type Room Location Floor Level 4.2 Electricity/Illumination 4.3 Electrical Hazards i I - 44 Security - y- - - --- - --------- ---- - - - -------------- - -- ---- -- -- ---------- _------- ------ ---__- -----_____T __—_ '---- --- 4.5 Window Condition 46 Ceiling Condition 4.7 Wall Condition 48 Floor Condition 49 Lead -Based Paint Are all painted surfaces free of deteriorated i paint? If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component? 4 1 C Smoke Detectors Not Applicable 4 1 Room Type Room Location --------------------------- ----------------- 4 2 Electricity/Illumination 4 3 Electrical Hazards - - ----- +--- ----- -....... -T - - - — - 4.4 Security _ 4 5 Window Condition 4 6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.9 Lead -Based Paint Not Applicable Are all painted surfaces free of deteriorated paint? I If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component? 4.10 Smoke Detectors HAPPY Software, Inc Page 3 of 7 Floor Level form HUD-52580 (3/2001) ref Handbook 7420.8 Item No. 4. Other Rooms Used For Living and Hails Yes No ' In - Pass Fail Conc.' 4-1 Room Type Room Location 4.2 Electricity/Illumination 4 3 Electrical Hazards 4 4 Security 4.5 Window Condition Final Approval Comment j Date (mm/ddlyyyy) Floor Level-- - -� - - - 46 Ceding Condition 47 Wall Condition 4.8 Floor Condition 49 Lead -Based Paint ;Not Applicable Are all oamted surfaces free of deteriorated paint'? If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component? 4.10 Smoke Detectors 41 Room Type Room Location --- 42 Electricity/Illumination -- - -- - - --- ... ---- ---- ----- -- -- -- - - - 4.3 Electrical Hazards 4.4 Security 4 5 Window Condition 4 6 Ceding Condition 4 7 Wall Condition - - --------- ----------- - - --- ---- -- - - - - - - - - -- =--- -- --------- 4 8 Floor Condition 4.9 Lead -Based PaintI Not Applicable Are all painted surfaces free of deteriorated paint? j If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component? 4.10 Smoke Detectors r 5. All Secondary Rooms CRooms-not_used for_livingj 5.1 None X Go to Part 6 5.2 Security 5.3 Electrical Hazards 5 4 Other Potentially Hazardous Features in these Rooms _- Floor Level _ HAPPY Software, Inc Page 4 of 7 form HUD-52580 (3/2001) ref Handbook 7420.8 Item 6. Building Exterior I Yes No In- ! Final Approval No. Pass Fail Conc., Comment Date (mm/dd/yyyy) 6.1 Condition of Foundation X 62 Condition of Stairs. Rails, and Porches X 6.3 Condition of Roof/Gutters X 6.4 Condition of Exterior Surfaces X r 6.5 Condition of Chimney X 66 Lead Paint. Exterior Surfaces I Not Applicable Are all painted surfaces free of deteriorated paint? If not, do deteriorated surfaces exceed 20 square feet of total exterior surface area? 6.7 Manufactured Home. Tie Downs v 7. Heating and Plumbing -- Adequacy of Heating Equipment q Y 9 q P --7.1 72 Safety of Heating Equipment 7 3 Ventilation/Cooking X 7.4 Water Heater X I 7 5 Approvabie Water Supply X- 7.6 - -- - -- - ---------- - Plumbing X 7.7 Sewer Connection X I 8. General Health and Safety - ---- - -- - -- ---- - - - 8 1 Access to Unit i - 8.2 -- Fire Exits X - -- 8.3 Evidence of Infestation X 84 Garbage and Debris X ! 8.5 Refuse Disposal 8.6 Interior Stairs and Common Halls 8.7 Other Interior Hazards i X 8.8 Elevators 8.9 Interior Air Quality 8.10 Site and Neighborhood Conditions X Lead Paint: Owner's Certification i 8.11 -Based X If the owner is required to correct any lead -based paint hazards at the property including deteriorated paint or other hazards identified by a visual assessor. a certified lead -based paint risk assessor, or certified lead -based paint inspector, the PHA must obtain certification that the work has been done in accordance with all applicable requirements of 24 CFR Part 35- The Lead -Based Paint Owner Certification must be received by the PHA before the execution of the HAP contract or within the time period stated by the PHA in the owner HQS violation notice. Receipt of the completed and signed Lead-8ased Paint Owner Certification signifies that all HQS lead -based paint requirements have been met and no re-inspspection by the HQS inspector is required. HAPPY Software, Inc Page 5 of 7 form HUD-52580 (3/2001) ref Handbook 7420.8 C. Special Amenities (Optional) This Section is for optional use of the HA. It is designed to collect additional information about other positive features of the unit that may be present Although the features listed below are not included in the Housing Quality Standards, the tenant and HA may wish to take them into consideration in decisions about renting the unit and the reasonableness of the rent. Check/list any positive features found in relation to the unit. Living Room High quality floors or wall coverings Working fireplace or stove I Balcony, patio, deck, porch Special windows or doors Exceptional size relative to needs of family Other (Specify) 2. Kitchen _� Dishwasher Separate freezer Garbage disposal Eating counter/breakfast nook Pantry or abundant shelving or cabinets Double oven/self cleaning oven, microwave Double sink High quality cabinets lAbundant counter-tcp space Modern appliance(s) Exceptional size relative to needs of family Other (Specify) 3. Other Rooms Used for Living High quality floors or wall coverings Working fireplace or stove Balcony, patio, deck, porch Special windows or doors ,i Exceptional size relative to needs of family I Other (Specify) 4. Bath Special feature shower head L Built-in heat lamp LJ Large mirrors Glass door on shower/tub Separate dressing room — Double sink or special lavatory jExceptional size relative to needs of family j Other: (Specify) 5. Overall Characteristics r Storm windows and doors _ ! Other forms of weatherization (e.g., insulation, weather stripping) _Screen doors or windows Good upkeep of grounds (i.e., site cleanliness, landscaping, _ condition of lawn) Garage or parking facilities Driveway Large yard Good maintenance of building exterior (Other(Specify) 6. Disabled Accessibility Unit is accessible to a particular disability Disability _,------ ___.- D. Questions to ask the Tenant (Optional) __ 1. Does the owner make repairs when asked? Yes __! No r__j 2. How many people live there? _ 3. How much money do you pay to the owner/agent for rent?3 4. Do you pay for anything else? (specify)_________ 5. Who owns the range and refrigerator?(insert O = Owner or T = Tenant) Range 6 Is there anything else you want to tell us? (specify) Yes No Refrigerator ___ Microwave Yes __. No HAPPY Software, Inc Page 6 of 7 form HUD-52580 (312001) ref Handbook 7420 8 E. Inspection Summary/Comments (Optional) Provides a summary description of each item which resulted in a rating of "Fail' or "Pass with Comments." Tenant ID Numoer _ Inspector Name - — Date of Inspection Address -----of In -- sp— ect--ed----Unit ------- mm/dd/- --- --- ----.. ',� �) Type of Inspection Item Number Reason for "Fail' or "Pass with Comments" Rating I hereby certify that the above comments from the inspection report are true and accurate. Tenant signature(s) and Date HAPPY Software, Inc Page 7 of 7 form HUD-52580 (3/2001) ref Handbook 7420.8 MERCY-2 OP ID: SD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Dufour Insurance Services, LLC 5611 Littler Drive Huntington Beach, CA 92649 Stephanie Dufour CONTACT NAME: Stephanie Dufour PA/�NN Ell. 714-369-2998 �_jn/c, No): 714-840-6357 ss: Stephanie@dufourinsurance.com ADDRESS, INSURER(S) AFFORDING COVERAGE NAIC # _ INSURER A: Great American Insurance COmpa__ INSURED Mercy House Living Centers P.O. Box 1905 Santa Ana, CA 92702 INSURER B. Great American Insurance Compa INSURERc:Travelers Property Casualty wsURERD:GreatAmerican Insurance_ Group INSURER E : INSURER F . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN —SR': - ------____ _--_____ .— - -- 'ADDL SUBR POLICY EFF ! POLICY EXP -- LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A A —' in X COMMERC. L GENERAL LIABILITY CLAIMS -MADE � OCCUR X Prof. Liability PAC426-08-82 PAC426-08-82 05/02/2016 05/02/2016 05/02/2017 05/02/2017 DAMAGE TO RENTED PREMISES (Ea occurrence) S 100,000 MED EXP (Any one person) S 10,000 PERSONAL a ADV INJURY s _ 1,000,000 A PAC426-08-82 05/02/2016 05/02/2017 X Sex Abuse/Miscond GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, X]J POLICY PRO I-LOC PRODUCTS - COMP/OP AGG S 2,000,000 IDed.- $0 $ A AUTOMOBILE LIABILITY I ANY AU i0 ALL OWNED X SCHEDULED AUTOS __ AUTOS NON -OWNED X J FARED AUTOS AUTOS I i PAC426-08-82 05/02/2016 05/02/2017 COMBINED SINGLE LIMIT !_(Ea nq____ S 1,000,000 _ _ _ S $ BODILY INJURY (Per person) BODILY I BODILY INJURY (Per accident) I PROPERTY DAMAGE PER ACCIDENT) $ ACV _ I Ded- $500 s X UMBRELLA LIAB � OCCUR EACH OCCURRENCE S 4,000,000 B EXCESS LIAB CLAIMS -MADE UMB 4260883 05/02/2016 05/02/2017 AGGREGATE I S 4,000,000 DED I X I RETENTIONS 100001 jI $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/?ARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED, (Mandatory in NH) N/A UB4216T17716 02/08/2016 02/08/2017 X WC STATU- OTH- TORY LIMITS ; ER_ E L EACH ACCIDENT — - - I S 1,000,000 E L DISEASE - EA EMPLOYEEI S 1,000,000 E L DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below D ICyber Liability NLP3642944 01/29/2016 01/29/2017 Occ 1,000,000 IPer Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space AMME ICHAEL E. GATES CITY ATTORNEY ITY OF HUNTINGTON BEACH CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EVIDENCE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Attachment 2 Budget Appropriations and Adjustments 1. A budget appropriation of $46,374 is requested in the Affordable Housing In -Lieu Fee Fund (Fund 217). 2. A budget appropriation of $45,626 is requested in the Low and Moderate Income Housing Asset Fund (Fund 352). 3. A budget adjustment of $28,667 is requested in the HOME FY 2011/12 fund (Fund 851). 4. A budget adjustment of $69,753 is requested in the HOME FY 2012/13 fund (Fund 852). 5. A budget adjustment of $344,092 is requested in the HOME FY 2013/14 fund (Fund 843). 6. A budget adjustment of $155,911 is requested in the HOME FY 2014/15 fund (Fund 1209). 7. A budget adjustment of $118,387 is requested in the HOME FY 2015/16 fund (Fund 1220). 8. Interfund Transfers (Various Funds): In addition, authorization is requested for interfund transfers of $113,984 between various HOME funds and a transfer of $4,403 from the General Fund to the HOME FY 2015/16 fund. Item 8. - 122 HB -310- City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ win1w.huntingtonbeachca.gov Office of the City Clerk Robin Estanislau, City Clerk September 21, 2016 Larry Haynes, Executive Director Mercy House P.O. Box 1905 Santa Ana CA 92702 Dear Mr. Haynes: Enclosed for your records is a fully executed copy of the "Home Recipient Agreement between the City of Huntington Beach and Mercy House (Tenant Based Rental Assistance." Sincerely, �&4va&d Robin Estanislau, CIVIC City Clerk RE:pe Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand