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HomeMy WebLinkAboutFamilies Forward - 2020-07-06 WvED F-,D City of Huntington Beach File #: 20-1726 MEETING DATE: 7/6/2020 REQUEST FOR CITY COUNCIL ACTION SUBMITTED TO: Honorable Mayor and City Council Members SUBMITTED BY: Oliver Chi, City Manager PREPARED BY: Ursula Luna-Reynosa, Director of Community Development Subject: Authorize and direct the City Manager to enter into the City's standard Professional Services Agreement with the following service providers for the Tenant Based Rental Assistance (TBRA) Program: 1) Families Forward, 2) Interval House, and 3) Mercy House; and, approve the Operating Guidelines Statement of Issue: The City provides a Tenant Based Rental Assistance (TBRA) Program funded by Federal HOME Investment Partnership (HOME) funds. The contracts with the existing service providers expired on June 30, 2020. The City Council is asked to authorize and direct the City Manager to execute the City's standard Professional Services Agreement with three service providers - Families Forward, Interval House, and Mercy House - to continue the TBRA Program. Financial Impact: There are sufficient fund balances to cover the cost of the three agreements, including up to $700,000 in the HOME Investment Partnership Funds (24080801 .89250, 24080901 .89250 and 24082700.89250), and up to $131 ,000 in HOME Administration Funds (24080901.69365). Recommended Action: A) Authorize and direct the City Manager to execute a Professional Services Agreement with "" Families Forward in an amount not to exceed $313,000; and B) Authorize and direct the City Manager to execute a Professional Services Agreement with Interval House in an amount not to exceed of $151,249; and*SEE Se-PIrPA-r� V C) Authorize and direct the City Manager to execute a Professional Services Agreement withi✓9erc House in an amount not to exceed of $309,079; and * se-E S FltG City of Huntington Beach Page 1 of 3 Printed on 7/1/2020 powe.i E6.44 LegistarTM File #: 20-1726 MEETING DATE: 7/6/2020 D) Approve the Operating Guidelines (Attachment#1), which will be attached to the Professional Services Agreement as an exhibit. Alternative Action(s): Do not authorize and direct the City Manager to execute the Professional Services Agreements, and do not approve the Operating Guidelines. Analysis: Annually, the City is allocated HOME funds from the U.S. Department of Housing and Urban Development (HUD). A Tenant Based Rental Assistance (TBRA) program, where funds are allocated to provide rental subsidy to individual households to afford housing costs such as rental assistance, security and utility deposits, is an eligible expense under HOME guidelines. The City has sponsored this program since 2015, helping hundreds of households avoid homelessness and find housing stability. Most recently, in light of COVID-19, the need for rental assistance has grown exponentially. In one month alone, more than 41 new households were provided with TBRA assistance. To continue this program, the City undertook a Request for Proposals (RFP) to seek service providers to administer the program moving forward. In May 2020, an RFP was released. Eight (8) service providers expressed interest and five (5) service providers submitted proposals in June 2020. A panel of raters, consisting of a member of the Homeless Task Force, Planning Division and Housing Division, reviewed the proposals and selected the top three candidates: Families Forward, Interval House, and Mercy House, described in greater detail below. Families Forward Families Forward began its collaboration with the City in 2018. While the other two service providers help individuals and families, Families Forward focuses on households with children. Since 2018, Families Forward has assisted 23 households, consisting of 47 people. It is projected that Families Forward will provide assistance to 20 homeless and/or nearly homeless families who plan to transition into permanent housing under a Professional Services Agreement in an amount not to exceed $313,000. Interval House The City implemented its first TBRA program in 2015 with Interval House. Under three contracts since 2015, Interval House has successfully housed 75 households (155 people). Additionally, in the month of April 2020, Interval House helped 37 new households, consisting of 86 people, which would have been displaced due to the impacts of COVID-19 on the economy. The impacts of the pandemic are still being felt in the community and it is anticipated that more households will need housing assistance before year's end. The proposed Professional Services Agreement with Interval House, in an amount not to exceed $151,249, will potentially provide financial assistance to at least 17 eligible extremely low, very low, and low income families and households. City of Huntington Beach Page 2 of 3 Printed on 7/1/2020 powereW Legistar- File #: 20-1726 MEETING DATE: 7/6/2020 Mercy House Mercy House has managed a TBRA contract with the City since 2016. Since that time, Mercy House has helped 46 households, consisting of 151 people, find housing stability. The proposed Professional Services Agreement with Mercy House, in an amount not to exceed $309,079, will potentially provide assistance to at least 18 extremely low, very-low, and low income households. All three service providers will work with the City's Homeless Task Force and Police Department to identify and target at-risk families and individuals with demonstrable ties to the City of Huntington Beach. The goal is to meet their immediate needs and create pathways that will allow them to quickly move into stable, self-sufficient, 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 funding. Environmental Status: A level of Environmental Review was completed and the program is Categorically Excluded, Not Subject to 58.5 per 24 CFR 58334(a) and 58.35(b) Tenant-Based Rental Assistance (U.S. Department of Housing and Urban Development). The proposed request consists of approval of agreements with service providers to provide financial assistance to at-risk households. No physical changes to the environment would result from approval and implementation of the agreements. As such, the request is covered by Section 15061 (b)(3) of the CEQA Guidelines, which states that CEQA applies only to projects which have the potential for causing a significant effect on the environment. Where it can be seen with certainty that there is no possibility that the activity in question may have a significant effect on the environment, the activity is not subject to CEQA. Strategic Plan Goal: Enhance and maintain high quality City services Attachment(s): 1. Operating Guidelines for the Tenant Rental Based Assistance (TBRA) Program City of Huntington Beach Page 3 of 3 Printed on 7/1/2020 powereW LegistarT" PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD FOR THE TENANT BASED RENTAL ASSISTANCE PROGRAM THIS AGREEMENT ("Agreement") is made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY," and FAMILIES FORWARD, a California nonprofit public benefit corporation hereinafter referred to as "CONSULTANT." WHEREAS, CITY desires to engage the services of a consultant to administer the City's Tenant Based Rental Assistance Program; and Pursuant to documentation on file in the office of the City Clerk, the provisions of the Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of professional service contracts have been complied with; and CONSULTANT has been selected to perform these services, NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows: 1. SCOPE OF SERVICES CONSULTANT shall provide all services as described in Exhibit "A," which is attached hereto and incorporated into this Agreement by this reference. These services shall sometimes hereinafter be referred to as the "PROJECT." CONSULTANT hereby designates Madelynn Hirneise who shall represent it and be its sole contact and agent in all consultations with CITY during the performance of this Agreement. 2. CITY STAFF ASSISTANCE CITY shall assign a staff coordinator to work directly with CONSULTANT in the performance of this Agreement. 20-8696agree/surfnet/professional svcs mayor 1 of 11 5/19-204082 3. TERM: TIME OF PERFORMANCE Time is of the essence of this Agreement. The services of CONSULTANT are to commence on July 6, 2020 (the "Commencement Date"). This Agreement shall automatically terminate one (1) year from the Commencement Date, unless extended or sooner terminated as provided herein. This Agreement can be extended by mutual agreement of the parties on an annual basis for a total of four years. All tasks specified in Exhibit "A" shall be completed no later than one year from the Commencement Date. The time for performance of the tasks identified in Exhibit "A" are generally to be shown in Exhibit "A." This schedule may be amended to benefit the PROJECT if mutually agreed to in writing by CITY and CONSULTANT. In the event the Commencement Date precedes the Effective Date, CONSULTANT shall be bound by all terms and conditions as provided herein. 4. COMPENSATION In consideration of the performance of the services described herein, CITY agrees to pay CONSULTANT on a time and materials basis at the rates specified in Exhibit "B," which is attached hereto and incorporated by reference into this Agreement, a fee, including all costs and expenses, not to exceed Three Hundred and Thirteen Thousand Two Hundred Dollars ($313,200). 5. EXTRA WORK In the event CITY requires additional services not included in Exhibit "A" or changes in the scope of services described in Exhibit "A," CONSULTANT will undertake such work only after receiving written authorization from CITY. Additional compensation for such extra work shall be allowed only if the prior written approval of CITY is obtained. 6. METHOD OF PAYMENT CONSULTANT shall be paid pursuant to the terms of Exhibit "B." 20-8696agree/surfnet/professional svcs mayor 2 of 11 5/19-204082 7. HOLD HARMLESS A. CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, judgments, demands and defense costs (including, without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent (or alleged negligent) performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement by CONSULTANT, its officers, agents or employees except such loss or damage which was caused by the sole negligence or willful misconduct of CITY. CONSULTANT will conduct all defense at its sole cost and expense and CITY shall approve selection of CONSULTANT's counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as limitation upon the amount of indemnification to be provided by CONSULTANT. B. To the extent that CONSULTANT performs "Design Professional Services" within the meaning of Civil Code Section 2782.8, then the following Hold Harmless provision applies in place of subsection A above: "CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY and its officers, elected or appointed officials, employees, agents and volunteers, from and against any and all claims, damages, losses, expenses, demands and defense costs (including, without limitation, costs and fees of litigation of every nature or liability of any kind or nature) to the extent that the claims against CONSULTANT arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of CONSULTANT. In no event shall the cost to defend charged to CONSULTANT exceed CONSULTANT's proportionate percentage of fault. However, notwithstanding the previous sentence, in the event one or more other defendants to the claims 20-8696agree/surfnet/professional svcs mayor 3 of 11 5/19-204082 and/or litigation is unable to pay its share of defense costs due to bankruptcy or dissolution of the business, CONSULTANT shall meet and confer with CITY and other defendants regarding unpaid defense costs. The duty to indemnify, including the duty and the cost to defend, is limited as provided in California Civil Code Section 2782.8. C. Regardless of whether subparagraph A or B applies, CITY shall be reimbursed by CONSULTANT for all costs and attorney's fees incurred by CITY in enforcing this obligation. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by CONSULTANT. 8. PROFESSIONAL LIABILITY INSURANCE CONSULTANT shall obtain and furnish to CITY a professional liability insurance policy covering the work performed by it hereunder. This policy shall provide coverage for CONSULTANT's professional liability in an amount not less than One Million Dollars ($1,000,000.00) per occurrence and in the aggregate. The above-mentioned insurance shall not contain a self-insured retention without the express written consent of CITY; however an insurance policy "deductible" of Ten Thousand Dollars ($10,000.00) or less is permitted. A claims-made policy shall be acceptable if the policy further provides that: A. The policy retroactive date coincides with or precedes the initiation of the scope of work (including subsequent policies purchased as renewals or replacements). B. CONSULTANT shall notify CITY of circumstances or incidents that might give rise to future claims. CONSULTANT will make every effort to maintain similar insurance during the required extended period of coverage following PROJECT completion. If insurance is terminated 20-8696agree/surfnet/professional sves mayor 4 of 11 5/19-204082 for any reason, CONSULTANT agrees to purchase an extended reporting provision of at least two (2) years to report claims arising from work performed in connection with this Agreement. If CONSULTANT fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the CITY with required proof that insurance has been procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to forthwith terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its time and materials expended prior to notification of termination. CONSULTANT waives the right to receive compensation and agrees to indemnify the CITY for any work performed prior to approval of insurance by the CITY. 9. CERTIFICATE OF INSURANCE Prior to commencing performance of the work hereunder, CONSULTANT shall furnish to CITY a certificate of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agreement; the certificate shall: A. provide the name and policy number of each carrier and policy; B. state that the policy is currently in force; and C. shall promise that such policy shall not be suspended, voided or canceled by either party, reduced in coverage or in limits except after thirty (30) days' prior written notice; however, ten (10) days' prior written notice in the event of cancellation for nonpayment of premium. CONSULTANT shall maintain the foregoing insurance coverage in force until the work under this Agreement is fully completed and accepted by CITY. The requirement for carrying the foregoing insurance coverage shall not derogate from CONSULTANT's defense, hold harmless and indemnification obligations as set forth in this Agreement. CITY or its representative shall at all times have the right to demand the original or a 20-8696agree/surfnet/professional svcs mayor 5 of 11 5/19-204082 copy of the policy of insurance. CONSULTANT shall pay, in a prompt and timely manner, the premiums on the insurance hereinabove required. 10. INDEPENDENT CONTRACTOR CONSULTANT is, and shall be, acting at all times in the performance of this Agreement as an independent contractor herein and not as an employee of CITY. CONSULTANT shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other payroll deductions for CONSULTANT and its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or the services to be performed hereunder. 11. TERMINATION OF AGREEMENT All work required hereunder shall be performed in a good and workmanlike manner. CITY may terminate CONSULTANT's services hereunder at any time with or without cause, and whether or not the PROJECT is fully complete. Any termination of this Agreement by CITY shall be made in writing, notice of which shall be delivered to CONSULTANT as provided herein. In the event of termination, all finished and unfinished documents, exhibits, report, and evidence shall, at the option of CITY, become its property and shall be promptly delivered to it by CONSULTANT. 12. ASSIGNMENT AND DELEGATION This Agreement is a personal service contract and the work hereunder shall not be assigned, delegated or subcontracted by CONSULTANT to any other person or entity without the prior express written consent of CITY. If an assignment, delegation or subcontract is approved, all approved assignees, delegates and subconsultants must satisfy the insurance requirements as set forth in Sections 9 and 10 hereinabove. 20-8696agree/surfneb'professional svcs mayor 6 of 11 5/19-204082 13. COPYRIGHTS/PATENTS CITY shall own all rights to any patent or copyright on any work, item or material produced as a result of this Agreement. 14. CITY EMPLOYEES AND OFFICIALS CONSULTANT shall employ no CITY official nor any regular CITY employee in the work performed pursuant to this Agreement. No officer or employee of CITY shall have any financial interest in this Agreement in violation of the applicable provisions of the California Government Code. 15. NOTICES Any notices, certificates, or other communications hereunder shall be given either by personal delivery to CONSULTANT's agent (as designated in Section 1 hereinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United States Postal Service, to the addresses specified below. CITY and CONSULTANT may designate different addresses to which subsequent notices, certificates or other communications will be sent by notifying the other party via personal delivery, a reputable overnight carrier or U. S. certified mail-return receipt requested: TO CITY: TO CONSULTANT: City of Huntington Beach Families Forward ATTN: Ursula Luna-Reynosa ATTN: Madelynn Himeise 2000 Main Street 8 Thomas Huntington Beach, CA 92648 Irvine, CA 92618 16. CONSENT When CITY's consent/approval is required under this Agreement, its consent/approval for one transaction or event shall not be deemed to be a consent/approval to any subsequent occurrence of the same or any other transaction or event. 20-8696agree/surfnet/professional svcs mayor 7 of 11 5/19-204082 17. MODIFICATION No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 18. SECTION HEADINGS The titles, captions, section, paragraph and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative of matters included or excluded from such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties or affect the construction or interpretation of any provision of this Agreement. 19. INTERPRETATION OF THIS AGREEMENT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. If any provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to law, and wherever there is any conflict between any provision contained herein and any present or future statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law. 20-8696agree/surfnet/professional svcs mayor 8 of 11 5/19-204082 20. DUPLICATE ORIGINAL The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of the date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instrument as against any party who has signed it. 21. IMMIGRATION CONSULTANT shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with the provisions of the United States Code regarding employment verification. 22. LEGAL SERVICES SUBCONTRACTING PROHIBITED CONSULTANT and CITY agree that CITY is not liable for payment of any subcontractor work involving legal services, and that such legal services are expressly outside the scope of services contemplated hereunder. CONSULTANT understands that pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive legal counsel for CITY; and CITY shall not be liable for payment of any legal services expenses incurred by CONSULTANT. 23. ATTORNEY'S FEES In the event suit is brought by either party to construe, interpret and/or enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each party shall bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its attorney's fees from the nonprevailing party. 24. SURVIVAL Terms and conditions of this Agreement, which by their sense and context survive the expiration or termination of this Agreement, shall so survive. 20-8696agree/surfnet/professional svcs mayor 9 of 11 5/19-204082 25. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 26. SIGNATORIES Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. 27. ENTIRETY The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiation, and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations, inducements, promises, agreements or warranties, oral or otherwise, have been made by that party or anyone acting on that party's behalf, which are not embodied in this Agreement, and that that party has not executed this Agreement in reliance on any representation, inducement, promise, agreement, warranty, fact or circumstance not expressly set forth in this Agreement. This Agreement, and the attached exhibits, contain the entire agreement between the parties respecting the subject matter of this Agreement, and supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof. 28. EFFECTIVE DATE This Agreement shall be effective on the date of its approval by the City Council. This Agreement shall expire when terminated as provided herein. 20-8696agree/surfnebprofessional svcs mayor 10 of 11 5/19-204082 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. CONSULTANT, CITY OF HUNTINGTON BEACH, a Families Forward municipal corporation of the State of California By: a4w 604.,0, 4-';/-0,XO6�ivvxj Mayor print name ITS: (circle one)Chairman/President/Vice President City Clerk AND INITIATED AND APPROVED: By. tt print name Director of Community Development ITS: (circle one)Secretary/Chief Financial Officer/Asst. Secretary-Treasurer REVIEWED AND APPROVED: City Manager APPROVED AS TO FORM: City Attorney Q11 COUNTERPART 20-8696agree/surfnet/professional svcs mayor 11 of 11 5/19-204082 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. CONSULTANT, CITY OF HUNTINGTON BEACH, a Families Forward municipal corporation of the State of California By: May r print name L� ITS: (circle one)Chairman/PresidentfVice President AND y Clerk el-11 P20 INITIATED AND APPROVED: By. U'j' � - 0. n( , print name ITS: (circle one) Secretary/Chief Financial Officer/Asst. Director of Community Development Secretary-Treasurer 79-7'-D f ROVED: City Manager APPROV D AS TO FORM: � 'L, —jz,*t City Attorney kv COUNTERPART 20-8696agree/surfnet/professional svcs mayor 11 of 11 5/19-204082 EXHIBIT "A" —Families Forward STATEMENT OF WORK Consultant shall administer a Tenant Based Rental Assistance Program for the City. Consultant shall abide by all federal, state and municipal laws, rules and regulations. The services provided by this agreement must specifically comply with all the requirements set forth in the HOME Program under Section 24, Part 92, of the Code of Federal Regulations. Consultant shall abide by all the City's Operating Guidelines. Consultant shall assist 20 new households during the course of this contract. EXHIBIT A EXHIBIT "B" —Families Forward Payment Schedule A. Budget Consultant shall perform its services within the following budget: HOME Funds: TBRA and Security Deposits: $220,000 HQS Inspections $ 32,000 Income Eligibility $ 9,000 Total: $261,000 Admin Funds: $ 52,000 Total City Contract: $313,000 Families Forward Match: $ 31,320 Total Budget: $344,520 B. Billing Consultant shall abide by all billing requirements in the Operating Guidelines. 1 Exhibit B PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD FOR THE TENANT BASED RENTAL ASSISTANCE PROGRAM Table of Contents 1 Scope of Services.....................................................................................................1 2 City Staff Assistance................................................................................................2 3 Term; Time of Performance.....................................................................................2 4 Compensation ..........................................................................................................2 5 Extra Work...............................................................................................................2 6 Method of Payment..................................................................................................2 7 Hold Harmless .........................................................................................................3 8 Professional Liability Insurance.............................................................................4 9 Certificate of Insurance.............................................................................................5 11 Independent Contractor............................................................................................6 12 Termination of Agreement.......................................................................................6 13 Assignment and Delegation......................................................................................7 14 Copyrights/Patents...................................................................................................7 15 City Employees and Officials..................................................................................7 16 Notices.........................................................................................7 17 Consent ....................................................................................................................8 18 Modification.............................................................................................................8 19 Section Headings .....................................................................................................8 20 Interpretation of this Agreement..............................................................................9 21 Duplicate Original....................................................................................................9 22 Immigration...............................................................................................................9 23 Legal Services Subcontracting Prohibited................................................................9 24 Attorney's Fees..........................................................................................................9 25 Survival.....................................................................................................................10 26 Governing Law.........................................................................................................10 27 Signatories.................................................................................................................10 28 Entirety 10 29 Effective Date.................................................................................10 FAMIFOR-01 RT N ACOROF DATE(MMfDD CERTIFICATE OF LIABILITY INSURANCE YYYY) B/zoi2o2o 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 have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER License#OM10410 CONTACT Armstrong/Robitaille/Riegle Business and Insurance Solutions PHE FAx 830 Roosevelt,Suite 200 (A CON No,Ext):(949)381-7700 (A/C,No):(949)487-6151 Irvine,CA 92620 E-MAIL .arrinfo@aleragroup.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Ins Co 18058 INSURED INSURER B:Security National Insurance ComDany 19879 Families Forward INSURER C 8 Thomas INSURER D: Irvine,CA 92618 I 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. INSR J TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP DIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR X PHPK2153320 7/1/2020 7/1/2021 DAMAGE TO R(EaENTEDISES occurrence) $ 1100,000 MED EXP(Any oneperson) 20,000 PERSONAL&ADV INJURY 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 3,000,000 F1POLICY PRO- LOC 3,000,000 JECT PRODUCTS-COMP/OP AGG OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO PHPK2153320 7/1/2020 7/1/2021 BODILY INJURY Perperson) $ OWNED SCHEDULED BODILY INJURY Peraccldent $ AUTEO�S ONLY AUTOpSWN X AUTOS ONLY X A�TOS ONLY PeOr accitlentDAMAGE $ A X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE PHUB729673 7/1/2020 7/1/2021 AGGREGATE 4,000,000 DED I X J RETENTION$ 10,000 B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ SWC1293116 7/1/2020 7/1/2021 _ STATUTE ER 1,000,000 E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Abuse/Molestation PHPK2153320 7/1/2020 7/1/2021 Occurrence 1,000,000 A Professional(E80) PHPK2153320 7/1/2020 7/1/2021 Occurrence 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Huntington Beach,its officials,agents,employees,representative and volunteers are named as additional insured on the General Liability per attached form,as required by written contract.Primary and Non-Contributory applies to the General Liaj i r f TO FORM By: ---�--- CERTIFICATE HOLDER CANCELLATION aMtes, City Attorney SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City Of Huntington Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y g ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Ursula Luna-Reynosa 2000 Main Street Huntington Beach,CA 92648 AUTHORIZED REPRESENTATIVE m 9a'ryl-i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: PHPK2153320 PI-GLD-HS (10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies,the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages,consult the policy contract wording. Coverage Applicable Limit of Insurance Page# Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments—Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments—Bail Bonds $5,000 5 Supplementary Payment—Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement—Janitorial Services Client Coverage $10,000 limit 6 Additional Insured—Newly Acquired Time Period Amended 6 Additional Insured—Medical Directors and Administrators Included 7 Additional Insured—Managers and Supervisors(with Fellow Included 7 Employee Coverage) Additional Insured—Broadened Named Insured Included 7 Additional Insured—Funding Source Included 7 Additional Insured—Home Care Providers Included 7 Additional Insured—Managers, Landlords, or Lessors of Premises Included 7 Additional Insured—Lessor of Leased Equipment Included 7 Additional Insured—Grantor of Permits Included 8 Additional Insured—Vendor Included 8 Additional Insured—Franchisor Included 9 Additional Insured—When Required by Contract Included 9 Additional Insured—Owners, Lessees, or Contractors Included 9 Additional Insured—State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Duties in the Event of Occurrence, Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury—includes Mental Anguish Included 11 Personal and Advertising Injury—includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury"or property damage"expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury"or"property damage" resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I—COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim, we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to$50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) LIABILITY, Subsection 2. Exclusions, Paragraph j. Damage to Property, Item(1) is deleted in its entirety and replaced with the.following: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a$30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word"fire" is changed to"fire, lightning, explosion, smoke, or leakage from automatic fire protective systems"where it appears in: a. The last paragraph of SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions; is deleted in its entirety and replaced by the following: Exclusions c.through n. do not apply to damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner.A separate limit of insurance applies to this coverage as described in SECTION III—LIMITS OF INSURANCE. b. SECTION III—LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5. above,the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V—DEFINITIONS, Paragraph 9.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4. Other Insurance, Paragraph b. Excess Insurance, (1) (a) (ii) is deleted in its entirety and replaced by the following: That is insurance for fire, lightning, explosion, smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) a. $1,000,000; or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION 1—COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a"violation(s)"of the Health Insurance Portability and Accountability Act(HIPAA). We have the right and the duty to defend the insured against any"suit,""investigation," or"civil proceeding" seeking these damages. However, we will have no duty to defend the insured against any"suit' seeking damages, "investigation,"or"civil proceeding"to which this insurance does not apply. 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional,Willful, or Deliberate Violations Any willful, intentional, or deliberate"violation(s)" by any insured. b. Criminal Acts Any"violation"which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V—DEFINITIONS is amended to include the following additional definitions: a. "Civil proceeding" means an action by the Department of Health and Human Services(HHS) arising out of"violations." b. "Investigation" means an examination of an actual or alleged"violation(s)" by HHS. However, "investigation"does not include a Compliance Review. c. "Violation" means the actual or alleged failure to comply with the regulations included in the H I PAA. Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) G. Medical Payments—Limit Increased to$20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III -LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION I—COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement, a. (3) (b) is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e. Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. I. Supplementary Payments SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS -COVERAGE A AND B are amended as follows: 1. b. is deleted in its entirety and replaced by the following: 1. b. Up to$5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these. 1.d. is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit', including actual loss of earnings up to$1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added: We will pay, on your behalf, defense costs incurred by an"employee" in a criminal proceeding occurring in the course of employment. The most we will pay for any"employee"who is alleged to be directly involved in a criminal proceeding is$25,000 regardless of the numbers of"employees," claims or"suits" brought or persons or organizations making claims or bringing "suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended to include the following: We will pay for the cost to replace keys and locks at the"clients" premises due to theft or other loss to keys entrusted to you by your"client," up to a$10,000 limit per occurrence and $10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, "employees", "managers", directors, trustees, authorized representatives or any one to whom you entrust the keys of a"client'for any purpose commit,whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows: a. "Client' means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee"as defined in Paragraph (1)above, who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee"does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an "employee." c. "Manager"means a person serving in a directorial capacity for a limited liability company. L. Additional Insureds SECTION II—WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees"are also insureds for"bodily injury"to a co- "employee"while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a)as it applies to managers of a limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source—Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers—At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You—Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) organization is an insured only with respect to liability for"bodily injury,""property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. h. Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. i. Vendors—Only with respect to"bodily injury" or"property damage"arising out of"your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) 'Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Sub-paragraphs (d)or(f); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. j. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract—Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for"bodily injury,""property damage"or"personal and advertising injury" but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations I. Owners, Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury,""property damage"or"personal and advertising injury"caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) m. State or Political Subdivisions—Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) 'Bodily injury,""property damage"or"personal and advertising injury"arising out of operations performed for the state or municipality; or (b) 'Bodily injury"or"property damage" included within the"products-completed operations hazard." M. Duties in the Event of Occurrence, Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a. is amended to include: This condition applies only when the"occurrence" or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b. is amended to include: This condition will not be considered breached unless the breach occurs after such claim or"suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,8.Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Recovery Against Others To Us is deleted in its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit"or transfer those rights to us and help us enforce them. Therefore, the insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time. R. Personal and Advertising Injury—Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of"personal and advertising injury" is amended as follows: 1. SECTION V—DEFINITIONS, Paragraph 14.b. is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; .2. SECTION V—DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race, color, religion, sex, age or national origin, except when: a. Done intentionally by or at the direction of, or with the knowledge or consent of: (1) Any insured; or (2) Any executive officer, director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling. The above does not apply to fines or penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company Policy# PHPK2153320 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 • www•huntingtonbeachca.gov I7,1909 Office of the City Clerk Robin Estanislau, City Clerk September 1, 2020 Families Forward Attn: Madelynn Hirneise 8 Thomas Irvine, CA 92618 Dear Ms. Hirneise: Enclosed is a copy of the "Professional Services Contract Between the City of Huntington Beach and Families Forward for the Tenant Based Rental Assistance Program" approved by the Huntington Beach City Council on July 6, 2020. Sincerely, Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand CITY OF HUNTINGTON BEACH TENANT BASED RENTAL ASSISTANCE PROGRAM PROGRAM GUIDELINES/OPERATING PROCEDURES (July 2020) I. INTRODUCTION Utilizing HOME Investment Partnership Program (HOME) funding, the City of Huntington Beach (City) has elected to assist certain eligible low income persons and families through funding by the Housing and Urban Development Department(HUD) by establishing a Tenant Based Rental Assistance Program (TBRA) that follows all of the requirements set forth in the HOME Program under Section 24, Part 92, of the Code of Federal Regulations (24 CFR 92). By partnering with local Service Providers, the Program will enable the City to meet the needs of participating tenant households by providing monthly rental assistance for up to 24 months (subject to funding availability.) H. TENANT SELECTION POLICY A. Current Residents of the City of Huntington Beach and Persons with Strong Ties to the City This program is designed to help current residents of the City and those with strong ties to the City. Priority shall be given to residents from the Huntington Beach Police Department, Huntington Beach Homeless Task Force, OC211 and other housing providers. 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. 1 843 B. 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). C. Intake Process As part of the intake process, the Service Provider 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, the Service Provider 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, the Service Provider 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. 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 60% 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 a notice of termination must be given from the Program. ■ Income limits for 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. 2 844 ■ Applicants must 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, applicants may self- report their income. In such cases, a written explanation must be provided as to why third-party verification or documentation was unavailable. ■ Likely changes in income may be considered when collecting income verification documentation. R 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 every six months. ■ 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. E. Eligibility Verification ■ Applicants will be re-qualified, including examination of source documentation, every six months or at the end of the lease term,whichever occurs earlier. ■ If an applicant has fluctuating income, and/or a change of household size or composition and/or fails to participate in all the policies of the program, the applicant may be requested to provide verification(s) more often, as reasonably necessary to confirm continued qualification and eligibility for the Program. ■ Applicants will be given written notice stating whether the Eligible Household was determined to be eligible for continued assistance under the Program. F. Waiting List Once the Program has reached maximum enrollment, a waiting list of prospective Eligible Households will be maintained. This list will be prioritized as follows: 3 845 ■ Clients who have been assessed for TBRA eligibility, completed intake process, and are ready for housing placement. Ready for housing placement means that the household has found a housing unit that meets TBRA requirements. ■ Clients who have been assessed for TBRA eligibility, completed intake process, and are searching for housing. ■ Clients who have been assessed for TBRA eligibility and pending intake. ■ Priority ranking will be given for Homeless Category 1 (24 CRF 91, 582 and 583), literally homeless participants from the streets or other locations not meant for human habitation, emergency shelters, or safe havens. G. Outreach and Collaboration with the City If funds are available to assist more City residents,the Service Provider is responsible for marketing and outreach activities to find prospective Eligible Households interested in the Program. Examples of outreach activities include conducting community presentations, contacting school districts, community based organizations and faith-based groups, and participating in community events to educate on TBRA resources available. III. SELECTION OF HOUSING UNITS A. Housing Unit Selection Eligible Households may elect to rent any Housing Unit in the City so long as the unit meets federal Housing Quality Standards (HQS) (Appendix D) 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. If an appropriate Housing Unit cannot be located within the City boundaries, a Housing Unit can be located outside of the City boundaries. 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: 4 846 Number in Unit Type Household One-bedroom Unit Up to 3 Persons Two-bedroom Unit Up to 5 Persons Three-bedroom Unit Up to 7 Persons Four-bedroom Unit Up to 9 Persons C. Property Inspections Prior to occupancy of any Housing Unit by an Eligible Household, and again during the annual verification process, a certified HQS inspector must 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) Appendix E; ■ 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. D. Housing Unit Rent Reasonableness Rental assistance paid on behalf of the Eligible Household must be in compliance with federal Rent Reasonableness requirements that mandate 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 the service providers. 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 5 847 ■ Amenities, services and utilities included in the rent. The Service Provider 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,the Service Provider 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 rent exceed the sum 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 The Service Provider will meet with and provide guidance to landlords participating in the Program regarding the requirements and procedures that impact landlords. Landlord Agreement(Appendix F) ■ The Service Provider 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 the Service Provider with notice of a lease termination, and reaffirm the tenant protections included in the Tenant Protection Agreement. ■ This contract will have an initial term of 6 months unless otherwise agreed between the Service Provider, tenant and the City. Lease Addendum for Tenant Protection (Appendix G) ■ 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; 6 848 ■ (3) Excusing ownerfrom 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. ■ Prohibit discrimination by the landlord against the Eligible Household. ■ The Service Provider will review the lease agreement to confirm its compliance with state law and all HOME Program requirements. Prior to signing the lease, the Service Provider must provide the City with the tenant's application, income eligibility documentation, IDIS form and lease terms for approval of acceptance into the program. If the City does not respond within two business days, the tenant is deemed approved. IV. 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 A rental assistance calculation will be completed for each Eligible Household. The calculation will determine each household's Program subsidy and share of the rent. The maximum amount of monthly assistance 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. 7 849 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 Payment Rent Reasonableness The Program must use the Rent Reasonableness Standard (Appendix E) to calculate monthly rental assistance. The payment standards represent the cost of rent and utilities for moderately priced units in Huntington Beach as well as those in surrounding Orange County cities. 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. The Orange County Housing Authority utility allowance schedule (Appendix H) shall 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. L Participant Agreement (Appendix H) The Service Provider 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 Rental assistance will be 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 the Service Provider and shall be based on continued Program compliance and ongoing need. 8 850 The Service Provider 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 80%AMI 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 changed since the previous evaluation, the participant's monthly rent responsibility will be adjusted accordingly. V. Security Deposits Security deposit assistance is available to Eligible Households. Such assistance shall be the lesser of: ■ Two months approved rent for the Housing Unit; or ■ 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. Vl. Utility Deposits Utility deposit assistance is available to Eligible Households. 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. The Orange County Housing Authority will annually establish the utility allowances for each year. (Appendix H) V1I. Annual Recertification, Termination of Assistance and Returning Households A. Annual Recertification Recertification of income and Program eligibility will occur annually. The Service Provider will gather source documentation for participating households to determine 9 851 annual income. Annual income must be calculated in accordance with 24 CFR Part S. If the total household income is above 80%AM],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. ■ 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. Vlll. Case Management The Service Provider should provide comprehensive case management services. The service model should maximize 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 periodically to update goals, monitor progress, and ensure long-term housing stability. The Service Provider may make all the following services available to their clients: individual housing and service plan, housing search and placement, financial 10 852 management, employment assistance, transportation services and behavioral health services. IX. RIGHT TO AN INFORMAL HEARING PROCEDURE Participating Tenant Households have the right to be heard by an impartial official, without prejudice. Program participants may appeal a proposed Program action that may have an adverse effect upon them by submitting a written Request for Hearing to the City of Huntington Beach,which include the Participating Tenant Household's objection, name and relationship of all potential parties, list of documents to be presented, current address and telephone number. Appeals must be filed within seven (7) calendar days of notification of proposed Program action. The informal hearing will be scheduled as soon as possible. The informal hearing shall be conducted in English. Notice of Informal Hearing will be issued at least ten days prior to the Hearing appointment, The Participating Tenant Household may bring person(s) to testify and/or documents at their expense. Participating Tenant Households may review pertinent file documentation so long as such documentation does not infringe on any other party's rights. X. CITY REQUIREMENTS A. Monthly Meetings and Reports Each month,the City will meet with each Service Provider via teleconference. At least 24 hours prior to the meeting, the Service Provider will provide an updated tenant chart. The City and Service Provider will discuss all tenants, potential applicants and other issues impacting the operations of the Program. B. Quarterly Summaries At the end of each quarter, the Service Provider will submit a summary of services provided. The summary shall include the number of new, continuing and existing households served in the quarter, any staffing changes, any billing issues, any outreach efforts and other issues impacting the administration of the Program., The Quarterly Summary is due within 45 days after the end of the quarter. C. Billing Requirements Service Providers shall submit their invoices no later than 60 days after the end of a service month. The invoices shall include a City coversheet for each household, a general ledger of all current clients, an updated IDIS form, if necessary, proof of all reimbursable costs, including rent checks, security deposits and staff time and any written communication with the City discussing exceptions or unusual circumstances regarding a household. Timely submission of invoices is required for City finance and budget purposes. 1 853 D. The City maintains the ability to make changes to the Operating Guidelines as City, State and Federal laws, ordinances and policies change. The City shall provide written notice to the Service Provider when a substantive change is made to the guidelines. IX. COMFORMANCE WITH HOME LAWS, RULES AND REGULATIONS The Program Guidelines/0perating Procedures must conform to all HOME laws,rules and regulations. To the extent Congress or the federal government makes changes to the laws, rules and regulations, particularly due to an exigent circumstance, the City has the discretion to modify these guidelines/procedures to align with federal laws, rules and regulations. At the time of the adoption of these Operating Guidelines, HUD has issued waivers and suspensions of HOME regulations due to COVID 19. The changes to the HOME regulations shall be in effect until December 31, 2020 unless otherwise modified by HUD. (Appendix J.) 12 854 Appendix A 855 SAMPLE TBRA APPLICATIONS APPLICATION FOR RENTAL ASSISTANCE (Pre-Application Version) APPLICANT NAME: Current Address: City, State, Zip Code: Home Phone: Alternate Phone: HOUSEHOLD COMPOSITION (List the Head of Household and all other members who will be living in th f;it. Give the relationship of each family member to the head.) n7 Member's Full Name Relationship Birthdate Age Sar;fi Security No. a , ': 44 �.. t a,.1401 .` Race of Head of Household (Check On tiori � ' (This information is being collected to assur�411a dance' , fair housing and equal opportunity rules.) ❑ White ❑ B1�k - ❑ Asian/Pacific Islander ❑ Native American/At m ative gy p: ❑ Hispanic Preference Information.' You mad . ali '=. N: eference for housing assistance if any of the �a�n be ven or youtamily. Please check any that apply to you. following circumsta, El Are you cuntly' ets El Are you cilor lF ing in substandard housing? If yes, pieasxpI Have _wbeen ° are you about to be) displaced from your housing? if ex p in: What is the teal income of all household members? (Include wages, salaries and tips; other income slas alimony, child support; and Social Security, AFDC or other benefits) 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(Program Administrator) to verify all information provided on this application. Head of Household Signature Date Spouse Signature Date ' Note: These are examples only. Insert the appropriate local preferences. 856 SAMPLE TBRA APPLICATIONS APPLICATION FOR RENTAL ASSISTANCE (Full Application Version) APPLICANT NAME: Current Address: City, State, Zip Code: Home Phone: Alternate Phone: HOUSEHOLD COMPOSITION (List the Head of Household and all other members who will be living irr uni give the relationship of each family member to the head.) wy ��. :. �. Member's Full Name Relationship Birthdate F e Sex So�ity No. t , k wlp . NEI 1115- IBM- Race of Head of Hous./rhvld (Check -Optio al (This information is being off .dbto assur pliance with fair housing and equal opportunity rules.) ❑ White r lack ❑ Asian/Pacific Islander skan© eomerEc Native ❑ Hispanic Prefer a Informkio 2 Yamay qualify for a preference for housing assistance if any of the y... ..�vp' foUowirt' circu I. verified for your family. Please check any that apply to you. = a c an ..v ❑ Are you cur�rebt€y homeless or living in substandard housing? If yQp plexplain: ❑ Have you been (or are you about to be) displaced from your housing? If yes, please explain: z Note:These are examples only. Insert the appropriate local preferences. 857 INCOME INFORMATION What is the total annual income of all household members? (Include wages, salaries and tips; other income such as alimony, child support; and Social Security, AFDC or other benefits) Member's Full Source of Income Annual Payment Basis Name Amount (weekly, monthly, etc.) 0 . � i ASSET INFORMATION Ary List the type and source of any family assets. Provt 'bofh :e cur refit ca 46�e and the estimated annual income from the asset. '" _ vX Member's Full Name Type and ke 0 Cash Value Annual (e.g.bank acco; , ves nets) of Asset income IN r api from Asset EXPEN RMATIO ❑ ff Yes No IM A61 ,5 u hod"„ehold have un-reimbursed medical expenses in excess of 3 percent riiiuLt° co ? ❑ Yes ❑ No Does y4 ousehold pay child care expenses for children under the age of 13 that ruyfamily member to work or go to school? ❑ Yes ❑ No Does your household pay care expenses for the care of a family member with disabilities that enable a family member to work? 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 [Program Administrator] to verify all information provided on this application. Head of Household Signature Date Spouse Signature Date 858 Appendix B 859 SAMPLE TBRA APPLICATIONS APPLICATION FOR RENTAL ASSISTANCE (Pre-Application Version) APPLICANT NAME: Current Address: City, State, Zip Code: Home Phone: 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.) Member's Full Name Relationship Birthdate Age Sex Social Security No. Race of Head of Household (Check One) -Optional (This information is being collected to assure compliance with fair housing and equal opportunity rules.) ❑ White ❑ Black ❑ Asian/Pacific Islander ❑ Native American/Alaskan Native ❑ Hispanic Preference Information.' You may qualify for a preference for housing assistance if any of the following circumstances can be verified for your family. Please check any that apply to you. ❑ Are you currently homeless or living in substandard housing? If yes, please explain: ❑ Have you been (or are-you about to be) displaced from your housing? If yes, please explain: What is the total annual income of all household members? (Include wages, salaries and tips; other income such as alimony, child support; and Social Security, AFDC or other benefits) 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 [Program Administrator] to verify all information provided on this application. Head of Household Signature Date Spouse Signature Date Note:These are examples only. Insert the appropriate local preferences. 860 SAMPLE TBRA APPLICATIONS APPLICATION FOR RENTAL ASSISTANCE (Full Application Version) APPLICANT NAME: Current Address: City, State, Zip Code: Home Phone: 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.) Member's Full Name Relationship Birthdate Age Sex Social Security No. Race of Head of Household (Check One) - Optional (This information is being collected to assure compliance with fair housing and equal opportunity rules.) ❑ White ❑ Black ❑ Asian/Pacific Islander ❑ Native American/Alaskan Native ❑ Hispanic Preference Information.z You may qualify for a preference for housing assistance if any of the following circumstances can be verified for your family. Please check any that apply to you. ❑ Are you currently homeless or living in substandard housing? If yes, please explain: ❑ Have you been (or are you about to be) displaced from your housing? If yes, please explain: 2 Note:These are examples only. Insert the appropriate local preferences. 861 INCOME INFORMATION What is the total annual income of all household members? (Include wages, salaries and tips; other income such as alimony, child support; and Social Security, AFDC or other benefits) Member's Full Source of Income Annual Payment Basis Name Amount (weekly, monthly, 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. Member's Full Name Type and Source of Asset Cash Value Annual (e.g.bank accounts, investments) of Asset Income from Asset EXPENSE INFORMATION ❑ Yes ❑ No Does your household have un-reimbursed medical expenses in excess of 3 percent of annual income? ❑ Yes ❑ No Does your household pay child care expenses for children under the age of 13 that enable a family member to work or go to school? ❑ Yes ❑ No Does your household pay care expenses for the care of a family member with disabilities that enable a family member to work? 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 [Program Administrator] to verify all information provided on this application. Head of Household Signature Date Spouse Signature Date 862 Appendix C 863 DECLARATION OF HOMELESSNESS STATUS Applicant Name: ❑ I 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/0/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 3 as homeless under this definition but whe ....W... ., 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,low 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- Mom: �,_NOW FRET. Any individual or family who .. .axM- 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 864 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 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: 865 Appendix D 866 Inspection Checklist U.S.Department of Housing OMB Approval No.2577-0169 and Urban Development (Exp.0713112022) 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.C.14371).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. 14370.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 Date of Request(mmlddlyyyy) Inspector Neighborhood/Census Tract Date of inspection(mm/ddlyyyy) Type of Inspection pate of Last Inspection(mmlddlyyyy) PHA Initial El Special Reinspection A. General Information Inspected Unit Year Constructed(yyyy) H tsirtg Type(check as appropriate) Full Address(including Street,City,County,State,Zip) 0 Single Family Detached Duplex or Two Family Row House or Town House Low Rise:3,4 Stories, Including Garden Apartment Number of Children in Family Under 6 Q High Rise;5 or More Stories 0 Manufactured Home Owner 0 Congregate Name of Owner or Agent Authorized to Lease Unit Inspected Phone Number r7 Cooperative Independent Group Residence Address of Owner or Agent © Single Room Occupancy © Shared Housing F-1 Other B. Summary Decision On Unit To be completed after form has been tilted out LFPassNumber of Bedrooms for Purposes Number of Sleeping Rooms of the FMR or Payment Standard clusive Inspection Checklist Item Yes No In- Final Approval No. 1.Living Room Pass Fail Conc. Comment Date(mmldd/yyyy) 1.1 Living Room Present 1.2 Electricity 1.3 Electrical Hazards 1.4 Security 1.5 Window Condition 1.6 Ceiling Condition 1.7 Wall Condition 1.8 Floor Condition Previous editions are obsolete Page 1 of 8 form HUD-52580(7/2019) 867 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;B=Other Item 1. Living Room (Continued) Yes No In- Finat Approval No, pas Fall Cont. Comment Date mmldd! 1.9 Lead-Based Paint Not Applicable Are all painted surfaces free of deteriorated Faint? 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 2.2 Electricity 2.3 Electrical Hazards 2.4 Security 2.5 Window Condition 2.6 Ceiling Condition 2.7 Wall Condition 2.8 Floor Condition 2.9 Lead-Based Paint 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 component? 2.10 Stove or Range with Oven 2.11 Refrigerator 2.12 Sink 2.13 Space for Storage,Preparation,and Serving of Food 3. Bathroom 3.1 Bathroom Present 3.2 Electricity 3.3 Electrical Hazards 3.4 Security 3.5 Window Condition 3.6 Ceiling Condition 3.7 Wall Condition 3.8 Floor Condition 3.9 Lead-Based Paint 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 component? 3.10 Flush Toilet in Enclosed Room in Unit 3.11 Fixed Wash Basin or Lavatory in Unit 3.12 Tub or Shower in Unit 3.13 Ventilation Previous editions are obsolete Page 2 of 8 form HUD-52580 (7/2019) 868 ..Item xe.4.Other Rooms Used For Living and Halls ; Yes Final A No In- ., __ _ Date mmldrovai Pass FallConc.;: d Comment 4.1 Room Code*and (Circle On (Circle One) Room Location Rkght/CentedLeft Front/CenterlRear _Floor Level 4.2 Electricity/Illumination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition y 4.7 Wall Condition i 4.8 Floor Condition 4.9 Lead-Based Paint ❑ INotApplicable 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? 4.10 Smoke Detectors 4.1 Room Code*and (Circle One) (Circle One) Room Location ❑ Right/Center/Left Front/Center/Rear _Floor Level 4.2 Electricity/Illumination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4,6 Ceiling Condition 4.7 Wail Condition 4.8 Floor Condition 4.9 Lead-Based Paint ❑ 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 component? 4.10 Smoke Detectors 4.1 Room Code*and (Circle One) (Circle One) RQom Location Right/Center/Left Front/Center/Rear ^� _Floor Level 4.2 Electricity/Illumination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition i 4.8 Floor Condition 4.9 Lead-Based Paint INotApplicable 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 component? Previous editions are obsolete Page 3 of 8 form HUD-52580(712019) 869 Item 4. Other Rooms Used For Living and Halls Yes I No In- Final Approval No. Pass Fall conc. Comment Date(mmrddryyyy) 4.1 Room Code* (Circle One) (Circle One) and Room Location RightICenter/Left Front/Center/Rear Floor Level 4.2 Electricity/Illumination 4.3 Electrical Hazards 4.4 Security j 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? If not,do deteriorated surfaces exceed two square feet per room and/or is more than 10%of a component? 4.10 Smoke Detectors 4.1 Room Cade*and (Circle One) (Circle One) Room Location Right/Center/Left Front/Center/Rear Floor Level 4.2 Electricity/lllu min ation 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.8 Lead-Based Paint 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 component? 4.10 Smoke Detectors 5. All Secondary Rooms (Rooms not used for living) 5.1 Alone Go to Part 6 5.2 Security 5.3 Electrical Hazards 5.4 Other Potentially Hazardous Features in these Rooms Previous editions are obsolete Page 4 of 8 form HUD-62580 (712019) 870 Item 6.Building Exterior Yes 1 No In- 1 Final Approval No. Pass Fall Cone. Comment !.Date(mmlditM) condition of Foundation 6.2 Condition of Stairs,Rails,and Porches 6.3 Condition of Roof/Gutters 6.4 Condition of Exterior Surfaces 6.5 Condition of Chimney 6.6 Lead Paint: Exterior Surfaces 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 7. Heating and Plumbing 7.1 Adequacy of Heating Equipment 7.2 Safety of Heating Equipment 7.3 Ventilation/Cooling 7.4 Water Heater 7.5 Approvable Water Supply 7.6 Plumbing 7.7 Sewer Connection 8. General Health and Safety 8.1 Access to Unit 8.2 Fire Exits 8.3 Evidence of Infestation 8.4 Garbage and Debris 8.5 Refuse Disposal 8.6 interior Stairs and Commom Halls 8.7 Other Interior Hazards 8.8 Elevators 8.9 Interior Air Quality 8.10 Site and Neighborhood Conditions 8.11 Lead-Based Paint:Owner's Certification Not Applicable 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-Based Paint Owner Certification signifies that all HQS lead-based paint requirements have been met and no re-inspection by the HQS inspector is required. Previous editions are obsolete Page 5 of 8 form HUD-52580(7/2019) 871 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. 1. Livinq Room 4. Bath High quality floors or wall coverings Special feature shower head J Working fireplace or stove Balcony, — Built-in heat lamp patio, deck, porch Special windows Large mirrors or doors - Glass door on shower/tub Exceptional size relative to needs of family Separate dressing room Other:(Specify) Double sink or special lavatory —1 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 S.Overall Characteristics Double sink Storm windows and doors —High quality cabinets ~Other farms of weatherization(e.g.,insulation,weather —Abundant counter-top space stripping)Screen doors or windows Modern appliance(s) Good upkeep of grounds(i.e.,site cleanliness,landscaping, — Exceptional size relative to needs of family condition of lawn) Other:(Specify) Garage or parking facilities —Driveway —Large yard Good maintenance of building exterior Other.(Specify) 3.Other Rooms Used for Living F] High quality floors or wail coverings F1 Working fireplace or stove Balcony, D patio, deck, porch Special windows 6. Disabled Accessibility or doors Exceptional size relative to needs of family Unit is accessible to a particular disability. Yes Na Other:(Specify) Disability Previous editions are obsolete Page 6 of 8 form HUD-62680(7/2019) 872 1. Does the owner make repairs when asked?Yes No 2. How many people live there? 3. How much money do you pay to the owner/agent for rent?$ 4. Do you pay for anything else? (specify) S. Who owns the range and refrigerator? (insert O =Owner or T=Tenant) Range Refrigerator Microwave 6. Is there anything else you want to tell us?(specify)Yes❑ No❑ Previous editions are obsolete Page 7 of 8 form HUD-52580(7/2019) 873 E.Inspection Summary/Comments(Optional) Provide a summary description of each item which resulted in a rating of"Fail'or"Pass with Comments." Tenant ID Number Inspector Date of Inspection(mm/ddtMy)Address of Inspected Unit ype of Inspection Initial Special Reinspection item Number Reason for"Fall'or"Pass with Comments"Rating Continued on additional page Yes 1:1No Previous editions are obsolete Page 8 of 8 form HUD-52580(4/2015) ref Handbook 7420.8 874 Appendix E 875 RENT REASONABLENESS CHECKLIST AND CERTIFICATION Proposed Unit Unit#1 Unit#2 Unit#3 Address Number of Bedrooms Square Feet Type of Unit/Construction ;�'. f�� Housing Condition Location/AccessibilityAD \T6y Amenities , Unit: P. ' T M Site: M `���: Y 'A qm Neighborhood: Age in Years Utilities (type) . Unit Rent Utility Allowance s � Gross Rent ` , tih Handicap Accessible? �N J :., 41 Mg CERTIFICA .N 5 Ao lianceayment Standard Prop ailrpct-Rpt + Utility Allowance = Proposed Gross Rent "'g Y Xr fCproved ren, es not exceed applicable Payment Standard of B. Rent Reasonableness Based upon a comparison with rents for comparable units, I have determined that the proposed rent for the unit [ ]is [ ] is not reasonable. Name: Signature: Date: 876 Appendix F 877 HOME RENTAL ASSISTANCE CONTRACT LANDLORD NAME &ADDRESS UNIT NO. &ADDRESS TENANT NAME Telephone No. This HOME Rental Assistance Contract("Contract") is entered into between the"City of Anytown, Department of " (program administrator)and the Landlord identified above. This Contract applies only to the Tenant family and the dwelling unit identified above. 1. TERM OF THE CONTRACT The term of this Contract shall begin on ' and end no later than m Z The Contract automatically terminates an the last day of the term of the Lea .LL • h 2. SECURITY DEPOSITS A. The (program administrator)will pay a security deposit to the Landlord in f[ ',: oun; . $ The Landlord will hold this security deps t during the period ; nt occupies the dwelling unit under the Lease. The Landlord shall crt ::(, with state and locally aws regarding interest payments on security deposits. e B. After the Tenant has moved from the dwellin it, the dlor&i0p6h, Ctlaject to state and local law, use the security deposit, including ark: ; erest on t` deposi imbursement for rent or any other amounts payable by the Tenarir� M er the .., " e. The Landlord will give the Tenant a written list of all items charged agagj the s`l ;ity e posit and the amount of each item. After deducting the amount used as re! ' lf,l:emen`ti Landlord, the Landlord shall promptly refund the full amount of the balance to theV.- efle, t/pro J administrator]. C, The Landlord shall immediately notify#U ma tie istrator)when the Tenant has moved from the Contract unit.., 3. RENT AND AMOUNTS PAYAB._, l`4T ► ,- AND (program administrator) A. Initial Rent W l�Ja total mori , ent payable to the Landlord for the first twelve months of this Contract is $ RP .. B. Rent Adjustmen Witt• lessr eft—4 days' notice to the Tenant and the (program a _ t mi�ngtor), th r may propose a reasonable adjustment to be effective no earlier than the ttl th of this tract. The proposed rent may be rejected by either the Tenant or the y rogram acinistra The Tenant may reject the proposed rent by providing the Landlord Insert the first day of the term of the Lease. z The maximum allowable length of a HOME Coupon Contract is two years. S Modify the paragraph based on PJ policy. 4 Insert the number of days notice the owner must provide of a rent increase. At least 60 days is recommended to enable the program administrator 30 days to review the rent and still enable the landlord to give the tenant 30 days notice. 878 HOME Rental Assistance Contract(Page Two) with 30 days'written notice of intent to vacate. if the program administrator rejects the proposed rent,the program administrator must give both the Tenant and the Landlord 30 days' notice of intent to terminate the Contract. C. Tenant Share of the RenL Initially, and until such time as both the Landlord and the Tenant are notified by the(program administrator), the Tenant's share of the rent shall be D. Program Administrator Share of the Rent. Initially, and until such time as ' the Landlord and Tenant are notified by the(program administrator), the (program adm+n or's) share of the rent shall be$ Neither the (program administrata E r NUD ssumes any obligation for the Tenant's rent, or for payment of any claim by the_ .' ner agar, a Tenant. j� The(program administrator's)obligation is limited to making rent ,y menu-tt ehaIf of the Tenant in accordance with this Contract. _ y �N E. Payment Conditions. The right of the owner to receive payments under t' " :_ontrall be subject to compliance with all of the provisions of the tract. The LandlorFe paid under this Contract on or about the first day of the mont 1Q which the paymeifi `s due. The Landlord agrees that the endorsement on the c e shall INE, fusive ev'd nce that the Landlord received the full amount due for the '_ ff I- sh§ a cert'fl�a�on that: 1 E ' 1. the Contract unit is in decent, safe unitary c tion, and&€-Rhe Landlord is providing .,. the services, maintenance and utiliti" £,greed t�,; : the Lease. " 2. the Contract unit is leased tc r cu !ryb Tenant named above in this Contract. 3. the Landlord has not receivedr#@r +ill note +ve any payments as rent for the Contract unit other than those identified`i° l ..r ontra 4. to the best of the Landlord's knowled'TM ,, the un used solely as the Tenant's principal place of residence v_ F. Overpayments. If the (p � m�anis #or)determines that the Landlord is not entitled to any payments received, in tiontWf tb emedies, the (program administrator) may deduct gr e ,w, the amount of atie overpaym tom ata ; ants due the Landlord, including the amounts due gn under any ote(xt tlta�l Assistan upon Contract. . � 01 4. HOUSING QUALI STANI? iD LANDLORD-PROVIDED SERVICES A. Up lord agF�s to maintain and operate the Contract unit and related facilities to provide en; safe and . 'tary housing in accordance with 24 CFR Section 882.109, including all of the services,,maim 'nce and utilities agreed to in the Lease. �r�a.-ram t:.� «N. p ogram 'nini strator) shall have the right to inspect the Contract unit and related adilities at I a.�nnually, and at such other times as may be necessary to assure that the unit is in ecent,•. , and sanitary condition, and that required maintenance, services and utilities are C. If the (program administrator) determines that the Landlord is not meeting these obligations, the program administrator shall have the right,even if the Tenant continues in occupancy,to terminate payment of the(program administrator'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 the(program administrator)in writing when eviction proceedings are begun. This may be done by providing the (program administrator)with a copy of the required notice to the tenant. 879 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 the (program administrator), any of which shall be entitled to involve any of the remedies available by law to redress any bre , or to compel compliance by the Landlord, r B. Cooperation in Quality Opportunity Compliance Reviews. The La : d shall cly with the (program administrator)and with HUD in conducting compliance' s anddi'nplaint investigations pursuant to all applicable civil rights statutes, Executiv der and all rela!hd Vim' 3 rules and regulations. 7. (Program administrator)AND HUD ACCESS TO LANDO D RECORDS A. The Landlord shall provide any information pertarslo the T r tract whic t :e (program administrator)or HUD may reasonably require _ { B. The Landlord shall permit the(program"n Enistrator),s LID, or is their authorized representatives,to have access to the pre se and the purposes of audit and examination,to have access to anbooks;rA rnis"is, papers, and records of the Landlord to 1s the extent necessary to determinkEy� liance: this Contract. I . % a 8. RIGHTS OF (Program administrator)y. LOR[ ¢. EACHES THE CONTRACT A. Any of the following sit VZOtute a bch e Contract: 1111h, ,.. tXv (1) If the Landlord has violal6 any o leg t n under this Contract; or ,gam a� � ` •�"' (2) If the La, d'grs ,�Jbi demons"c`;a d any intention to violate any obligation under this Contract; or � fir: (3) If the LandloA., n dmmitfedkany fraud or made any false statement in connection with the Q� act or mitted fraud or made any false statement in connection with any RW_F6,eral houslit" "ssistance program, : d tThe '�ti �'artd� tnedies under the Contract include recovery of overpayments, � tt; tion or r uction of payments, and termination of the Contract. If the (program administrator) ermines that a breach has occurred, the program administrator may exercise any of its rat t r remedies under the Contract. The (program administrator)shall notify the Lan Id :, + ng of such determination, including a brief statement of the reasons for the determination. The notice by the PHA to the landlord may require the Landlord to take corrective action by a time prescribed in the notice. C. Any remedies employed by the (program administrator) in accordance with this Contract shall be effective as provided in a written notice by the (program administrator)to the Landlord. The (program administrator'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. 880 HOME Rental Assistance Contract(Page Four) 9. PHA RELATION TO THIRD PARTIES A. The (program administrator) 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 the(program administrator) and this Conii,�'�' t does not create or affect any relationship between the (program administrator) and any Ir to the Landlord, or any suppliers, employees, contractors or subcontractors used by hst andlord'n connection with this Contract. r C. Nothing in this Contract shall be construed as creating any right of# . n ', or a#hirpy (other than HUD)to enforce any provision of this Contract or to asses aim agai �w HUD, the(program administrator) or the Landlord under this Contract. 10. CONFLICT OF INTEREST PROVISIONS1 A. No employee of the(program administrator)'t�0t�artltes� ey or infues decisions with respect to the Rental Assistance Program 'no pulfofficia�l ter of a governing body or state of local legislator who exercise i�nctions a spansibtliwith respect to the program shall have any direct or indirect r est dpl, is person' tenure, or for one year thereafter, in this contract or in antocee :. its arising from the Contract or to any benefits which may arise from it. ..,_',. fi V10W-0 11. TRANSFER OF THE CONTRACTWf The Landlord shah not trarZfanl form�lis Cdvct without the prior written consent of the (program administrator) TRU-1 0gr tnl,admr istrato� 'shall give its consent to a transfer if the transferee agrees in writing (in am a take to the (program administrator))to comply with all terms and conditi cis of this Connta �� 12. ENTIRE AGREE` ( 1F: ERPRET ;.E?�JN 000 A This Contract cod►_ 11 entry .reement between the Landlord and the program �t tbi t ator. N ges in this Contract shall be made except in writing signed by both the RE andf i' and the (Ssrogram administrator). The Oo �adt I terpreted and implemented in accordance with HUD requirements. . ... . ME ` 881 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 tndlord. Landlord Name(Type or Print): (Program administraa. Representive (Type of Print): r Imrr (Signature/Date) (Signature/Date) WARNING: 18 U.S.C. 1001 provides, among other things that wTia ver knowingly,and willingly makes or uses a document or writing containing any false,fictitli t,1 �fr 68 t statemn or entries, in any matter within the jurisdiction of any department or �y of tlUnitetessxil be fined not more than $10,000, or imprisoned for not more than five Tars,or N, � 140 LANDLORD'S CHECK TO BE MAILED TO, SS fiL NAME(S) I—.�.. r„ „ ADDRESS BONE* w� u IGNIAl.tA ��E OF OWNER DATE Sle'I ATURE OF OWNER DATE h q,_ N� 882 Appendix G 883 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 ;``` renced unit is being amended to include the provisions of this d i hdun f use the Tenant has been approved to receive rental assit ce f er the [program administrator's] HOME Rental Assistance Pry 'i=. Under,. the Rental Assistance Program, the [program administratb ill monthly payments to the Landlord on beh4,1 the Tenant. T4 The Lease has been signed by then t won fi onditioat the [program administrator] and Lanke1"w�ll�p mpl eta HOME Rental Assistance Contract T . ' ease ski:l! not tx a effective unless the Contract has been M uted M oth the Landlord and the [p ro ram administrator , ftctivday of the term of the 9 ] 660 Lease. B. Conflict with Ot er Provists % he Mse. In case of any conflict between the pr s n of th! dd+a ._ m and other sections of the A end shall prevail, Lease, the proviiS-„o3h &r f C. Terms,014he Lease the term shall begin on and shall continue�nfil { he Le is terminated by the Landlord in accorda cwitti ia_ y, ble tate and local Tenant/Landlord laws; (2) the Leaselft ter�ated` r the Tenant in accordance with the Lease 'Ef,'w^'hR' �i3✓�k��S � � y mutua ,-greemen#during the term of the Lease; or(3) termination k he HOME Rental Assistance Program Contract by the ` adAistrator]. gg_ON `dental Al11istance Payment. Each month the[program dnl Is. will make a rental assistance payment to the Landlord orb K If 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/[program administrator]) 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. 884 (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 (TenanV[program administrator]). F. Utilities and Appliances. The utilities and appliances li4 in Column 1 are provided by the Landlord and included in,P- a rent.The utilities and appliances listed in Column 2 below ar _o includ w cin the rent and are paid separately by the Tenant. UTILITYIAPPLIANCE Included in Re t Tenant Pai•,l Y Garbage Collection Y w Water/Sewer Heating Fuel (specify) JS ary Lights, electric "> Cooking Fuel (specify) •� ��� Other(specify) Ref rigerato . Stove/Range r� G. House rs Ff ehold members authorized to live in this unit are tenant 11sd b €d� Aie may not permit other persons to join Me Houses I— lhouf'i•l8 ifying the [program administrator] and is fining tl YandI rd s permission. Household members: Y' Standards. The Landlord shall maintain the . c? ttg>�glua H I y .. . v�elling u t, common areas, equipment, facilities and appliances in decent, _ : e, and sanitary condition (as determined by Section 8 ogysMm! uality Standards). =`- i� A0 I. 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 the [program administrator] in writing when eviction proceedings are begun. This may be done by providing the [program administrator] with a copy of the required notice to the Tenant. 885 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. Agreerp i by the Tenant not to hold the Landlord or Landlord's ag�iegally i, responsible for any action or failure to act, whet., nten I or negligent. y (4) Waiver of Legal Notice. Agreement by the Tenant tha I bl ee Landlord may institute a lawsuit witho.tt otice to the TAS"b"t,0 (5) Waiver of Court Proceedings for Evictro greement by they Tenant that the Landlord may eyi, J� TensFamily r i ithou# instituting a civil court proceed#re, s in �Jc the opportunity to present a dA or(it efore Yq sion by the �� F N court on the rights of the patters A (6) Waiver of Jury Tnal +ltk�onza #o the Landlord to waive the Tenant's right to a trim (7) Waiver of Right to App Degstpt. Authorization to the Landlord to)y �uethe Tel nt� Elgt toappeal a court decision or waive the 11er� right to- ue to" -event a judgment from being �. put into effect W ME N (8) Ten ,LChargea,bl nth C f Legal Actions Regardless of OutYp t Lthe Law§K Agreement by the Tenant to pay lawyers fe pxQ#herea1 costs whenever the Landlord decides to sue h �t o the Tenant wins. SOME f � . ndiscrination. The Landlord shall not discriminate against the Teaw., ,ovision of services, or in any other,manner, on the grot tds�ag, race, color, creed, religion, sex, handicap, national rign, 71, rriilial status. T91 SIGNATURES LANDLORD SIGNATURES By: LANDLORD NAME: (Type or Print Name of Tenant Representative) By: (Signature/Date) (Type or Print Name of Landlord Representative) By: (Type or Print Name of Tenant Representative) (Signature/Date) (Signature/Date) 886 Appendix H 887 PARTICIPANT CONTRACT Service Provider's TBRA Program aims to provide homeless individuals with short-term rental subsidies,accompanied by intensive services,in order to rapidly transition homeless individuals into housing and prevent them from remaining homeless. At the same time,these services are designed to support individuals in achieving housing independence and realizing their full potential. I/We met with the Housing Stability Specialist and have elected to: Participate in the TBRA program Not Participate in the TBRA program Now that I have been accepted into the program,I understand that in order to remain eligible for services,I agree to comply with the following Next Step Participant rules/guidelines: • I understand that I am responsible for managing all additional living expenses'(i.e.utilities,sewage,water, garbage,food,etc.....)above and beyond what is paid for by my subsidy: • I agree to schedule and meet with my Housing Stability Specialist as deterrhined neeessary but no less than one time per month with all meetings being at my housing location unless otherwise agreed upon.I agree that if there is a conflict with the schedule, it is my responsibility to contactthe Housing Stab ilitySpecialist to.:address/re- schedule the meeting. • I agree that there will be a mutual respect between my Housing,Stability.-Specialist and myself. • I am aware that the Housing Stability Specialist may;Complete a housing inspection:during the home visits. • I agree to take initiative and cooperate in developing a Self Sufficiency Plan whW ny Housing Stability Specialist that identifies and seeks to resolve barriers to permanent housing including,but not limited to; o gaining or increasing employment/income to'a_living wage.,through job training/basic education o address debt issues' o learn or improve money management skills o increase knowledge of housing options ani opportunities in the community. • I agree to complete and..follow a budgetand savings plan. • I agree to provide documentation.,as needed by my Housing Stability Specialist to provide proof of employment/income employment search/applyng, attendance records at job trainings,G.E.D.classes,proof of debt payments,etc.. during scheduled`meetings. • I agree to notify my Housing Stabilization Case Manager of any lease violations or concerns. • I agree not to sublet ori.aye anyone not already approved by the lease agreement to stay at the rental property for an extended period of tine, My signature below indicates that I"understand what is expected of me by the TBRA Program and that in order to continue to be eligible for participation in the program I must follow these rules/guidelines. In addition I will be an active participant in my Self Sufficiency Plan. Participant Name Participant Signature Date Participant Name Participant Signature Date Housing Stability Specialist Signature Date [Type here] 888 Appendix I 889 Housing Choice Voucher Program Effective Date: October. 1, 2019 BeslxoF GAS i Cooking 3 4 5 7 i { Heating 14 17 18 20 23 25 l , Water Heater.. .„5.�--�. �...�13 18r.,. ,. 23 -2S ...n... ELECTRIC j i 1 Basic.'' 26 31 44 j Cooking 5 6 11 16 19 23 i Heating 17 20 22 25 i Water Heater 16 20 28 34 40 46 L .r.._- OTHER j Water 42 45 65 97 127 158 E. Trash&Sewer 26 Ref►igerator_ i ' Stove 7 i i Orange County Housing Authority 890 Appendix J 891 ADDENDUM TO OPERATING PROCEDURES FOR TENTANT BASED RENTAL ASSISTANCE PROGRAMS On April 10, 2020, the Housing and Urban Development Department, HUD, issued two memoranda, April 10, 2020 Memorandum — Availability of Waivers and Suspensions of the HOME Program Requirements in Response to COVID-19 Pandemic and April 10, 2020 Memorandum — Suspensions and Waivers to Facilitate Use of HOME-Assisted Tenant-Based Rental Assistance (TBRA) for Emergency and Short-term Assistance in Response to COVID-19 Pandemic. The memoranda prioritized the immediate housing needs of those impacted by COVID- 19 and the prevention of the spread of COVID-19 and to achieve such ends, provided for numerous waivers and suspensions in current federal regulations and policies. The City's Community Development Department applied for and was granted the waivers and suspensions on April 22, 2020. The following waivers and suspensions, among others, were granted and impact the administration of the HOME Tenant Rental Based Assistance Program (TBRA) which provides rental assistance to low income individuals and families in Huntington Beach, April 10, 2020 Memorandum—Availability of Waivers and Suspensions of the HOME Program Requirements in Response to COVID-19 Pandemic • HOME Program - 10% Administration and Planning Cap • HOME Program — Income Documentation • HOME Program — On-Site Inspections of HOME-assisted Rental Housing • HOME Program - Annual Inspection of Units Occupied by Recipients of HOME Tenant-Based Rental Assistance (TBRA) April 10, 2020 Memorandum — Suspensions and Waivers to Facilitate Use of HOME-Assisted Tenant-Based Rental Assistance (TBRA)for Emergency and Short-term Assistance in Response to COVID-19 Pandemic • HOME Program—Consolidated Plan-HOME Certification, Analysis of Local Market Conditions, and Citizen Participation • HOME Program —Tenant Selection and Targeted Assistance • HOME Program - Eligible Tenant-based Rental Assistance Costs and Maximum TBRA Subsidy • HOME Program - Term of Rental Assistance Contract • HOME Program —Tenant Protections-Lease • HOME Program — Housing Quality Standards • HOME Program — Annual Inspection of Units Occupied by Recipients of HOME TBRA • HOME Program - Income Determinations HUD will be issuing further guidance on the waivers and suspensions. The City will adopt these guidelines within the program's operating procedures to ensure low income residents of Huntington Beach will be afforded maximum access to this 892 program. The City will be required to provide written documentation of the changes to operating procedures and work closely with the service providers to ensure compliance of the modified regulations during the pandemic and its aftermath. 893 7/7/2020 Tenant Based Rental Assistance (TBRA) Program : July 6, 2020 n Federal HOME Investment Partnership Funds Each year, the Department of Housing and Urban Development provides local jurisdictions with HOME funds to provide for housing for lower income households. �.,n Since 2015, the City Council has approved HOME funds to sponsor a Tenant Based Rental Assistance Program to help households with rental, security deposit and utility assistance. SUPPLSMENTAL COMMUNICATION Meeting Data: 1 Agenda Item No.; 7/7/2020 Partnership with Service Providers: Working with Community Based Organizations Interval House: Partner with the City since 2015. Focus on families with domestic violence. Has assisted over 75 households/155 people overcome housing insecurity. Mercy House: Partner with the City since 2016. Focus on very low and extremely low income households. Has assisted 46 households/151 people overcome housing insecurity. Families Forward: Partner with the City since 2018. Focus on households with minor children. Has assisted 23 households/47 people overcome housing insecurity. MR COVID-19 Housing Needs ' Since April 2020, the need for housing assistance has sky- rocketed due to the after-effects of COVID-19. In April, Interval House assisted 37 new households/86 people who could no longer afford their rents due to job loss or reduction of hours. As the pandemic continues, the service providers anticipate an increase in households needing housing assistance. The need will continue to grow. 2 7/7/202o Recommended City Council Action Authorize and Direct the City Manager to execute the City's standard Professional Services Agreement to provide Tenant Based Rental Assistance (TBRA) services with Families Forward, Interval House and Mercy House. Approve the Operating Guidelines. Questions? 3