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Families Forward - 2024-07-01 (4)
• HOME SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD (Tenant Based Rental Assistance) This HOME SUBRECIPIENT AGREEMENT (Tenant Based Rental Assistance) ("Agreement") is made and entered into as of July 1, 2024 ("Effective Date")by and between the CITY OF HUNTINGTON BEACH, a municipal corporation and charter city ("City"), and FAMILIES FORWARD, a California nonprofit public benefit corporation ("Subrecipient"). • RECITALS A. City is a California municipal corporation and charter city under the laws of the State of California. B. City has applied for and received funds ("HOME Funds") from the United States Department of Housing and Urban Development ("HUD") pursuant to the HOME Investment Partnerships Act and HOME Investment Partnerships Program, 42 U.S.C. §12701, et seq., and the implementing regulations set forth in 24 CFR § 92.1, et seq. (together, "HOME Program") for the purposes of strengthening public-private partnerships to provide more affordable housing, and particularly to provide decent, safe, sanitary, and affordable housing for very low income and low income citizens of Huntington Beach in accordance with the HOME Program. As used herein, the HOME Program includes the HUD Final Rule set forth at 78 FR 142, adopted July 24, 2013, which adopts substantial amendments to the HOME Program regulations set forth at 24 CFR Part 92. C. City is currently implementing a coordinated one-year strategy and program to • provide financial assistance to eligible extremely low, very low and low income families and households to enable such households to secure housing available at an affordable housing cost in the City. D. City has developed a Tenant Based Rental Assistance Program to assist households in the City, who are homeless or at imminent risk of homelessness, preference given to veterans and seniors, to enable such households to transition into permanent, supportive housing. • • E. City wishes to engage the Subrecipient to assist the City in utilizing HOME Funds to provide tenant based rental assistance, security deposits and utility assistance to veteran and senior residents of the City, in accordance with the terms and provision set forth in this Agreement. NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows: 1 ARTICLE 1 SCOPE OF SERVICES 1.1 Scope of Services. During the entire Term (defined below) of this Agreement, Subrecipient shall administer the City's HOME-funded Tenant Based Rental Assistance Program ("TBRA Program"), all in accordance with this Article 1 (collectively, the "Services") and the Scope of Services and TBRA Program Operating Guidelines attached hereto as Exhibit A. In connection with the Services, Subrecipient shall comply with all requirements of the HOME Program, this Agreement and all applicable federal, state and local laws and regulations. Subrecipient shall further take all reasonable actions necessary to enable City to comply with City's obligations under the HOME Program relating to the TBRA Program. The Subrecipient shall perform the Services set forth in this Article 1 in furtherance of the TBRA Program. 1.2 Marketing and Outreach; Application Process. (a) Marketing and Outreach. Subrecipient shall undertake affirmative marketing and outreach activities to find prospective Eligible Households interested in the TBRA Program, all in accordance with HUD's Affirmative Fair Housing and Marketing regulations and the City's Affirmative Fair Housing Marketing Plan, when adopted. Subrecipient shall describe its marketing and outreach efforts in monthly progress reports submitted to the City under this Agreement,as described in Exhibit B. (b) Waiting List. Subrecipient shall maintain a waiting list of prospective Eligible Households. The waiting list shall be prioritized first based on the most urgent need as set forth in the TBRA Program Operating Guidelines, prospective Eligible Households of equally urgent need will be helped on a first come-first served basis, based on the date and time of referral or initial direct contact with the Subrecipient. (c) Intake Process. Upon being contacted by a prospective Eligible Household recruited through Subrecipent's affirmative marketing and outreach efforts, subrecipient shall initially meet with such prospective Eligible Household to fill out an Initial Qualification Document in substantially the form attached to the TBRA Program Operating Guidelines in Exhibit A, including an income calculation based on two months of source documentation (bank account statements, pay stubs, etc.)to prequalify such prospective Eligible Household. Subrecipient shall then meet with prequalified Eligible Households to • determine and verify their qualifications and eligibility for assistance under • the TBRA Program, provide such prequalified Eligible Households with the TBRA Program application and other documentation described below, assist prospective Eligible Households with the completion of the application and gross income calculation worksheet and qualify Eligible Households for the 2 TBRA Program. Subrecipient shall provide every prequalified Eligible Household with all of the following documentation. (i) TBRA Application in the form attached to the TBRA Program Operating Guidelines in Exhibit A,or as otherwise approved in writing by the Director of Community Development ("Director"). The TBRA Application shall solicit information regarding each applicant household's income and assets, household size and composition (number of children and adults), names of household members, Housing Unit (defined below) size and location preferences, specific needs and considerations, and a race/ethnicity survey. Examples of'acceptable documental to confirm recent residency include: • Copy of previous lease • Copy of previous utility bill • Written confirmation of residency from a previous landlord, or proof of residency in transitional living facility • Copy of school records confirming previous residency Examples of proof of strong ties to the Community include: • Current residency of an immediate family member — mother, father, sibling, child, or grandparent • Proof that the individual and/or their dependent(s) attended K- 12 school in Huntington Beach (ii) Declaration of Homelessness Status or Declaration of At-Risk of Homelessness States, as appropriate, in the forms attached to the TBRA Program Operating Guidelines in Exhibit A. (iii) Rental Assistance Contracts for the Landlord and the Eligible Household, in the forms attached to the TBRA Program Operating Guidelines in Exhibit A. (iv) Household Budget Worksheet in the form attached to this Agreement as Exhibit D. (v) Lead-Based Hazard Information Pamphlet"Protect Your Family from Lead in Your Home"attached to this Agreement as Exhibit E. (d) Guidance for Eligible Households. Subrecipient shall meet with prospective Eligible Households throughout the application process and shall continue to meet with and counsel each Eligible Household regarding the TBRA Program, the Eligible Household's responsibilities as participants of the TBRA Program,and the goals and objectives of the TBRA Program. • 3 1.3 Determination of Eligibility. Subrecipient shall qualify all Eligible Households in accordance with the selection criteria described in this Section. Further, for all Eligible Households Subrecipient shall implement the selection criteria and policies in compliance with the City's Consolidated Plan and the City's housing needs and priorities. (a) Eligible Household. As used in this Agreement, "Eligible Household"refers to extremely low income households that are(i) currently residents in the City of Huntington Beach; and(ii) currently homeless or at risk of homelessness. (i) As used in this Agreement "homeless" is defined at 24 CFR 91,582 and 583,as defined by HUD. (ii) For purposes of determining eligibility for the TBRA Program, a prospective Eligible Household's (or for continuing. compliance, a participating Eligible Household's) gross annual income shall be determined in accordance with 24 CFR 5.609, with the allowable exclusions from income established at 24 CFR 5.611, For purposes of this Agreement, annual income means the gross amount of income from all sources,including assets,for all adult household members that is anticipated to be received prospectively during the 12-month period following the date of application and before any deductions are taken (and for a participating household, income anticipated for the 12 months following verification described in §1.3(b)(ii) below.) When collecting income verification documentation, Subrecipient may also consider any likely changes in income. (iii) For purposes of this Agreement and the TBRA Program, income limits for extremely-low, very-low and low income households are established annually by HUD for the Orange County income limit area. (b) Income Verification. (i) Initial Verification. To determine if TBRA Program applicants (collectively, "Applicants") are income-eligible, Subrecipient must verify each Applicant's household income using source documentation such as wage statements, interest statements, unemployment compensation statements, bank account statements and other documentation types approved by HUD. Once an initial income verification is completed, the Subrecipient is not required to re- examine the Eligible Household's income unless six months has elapsed before assistance is provided. (ii) Annual Eligibility Verification. Subrecipient shall annually re- certify income and re-qualify each Eligible Household, including examination of source documentation. Household income must be no 4 greater than 80 percent of AMI to remain eligible for assistance. For households found no longer eligible, assistance must be terminated following a 30-day notification period. (c) Verification of Eligibility. Subrecipient shall collect and examine source documentation submitted by the Applicant to verify the identity of the members of the Eligible Household. Subrecipient shall make a determination that the Eligible Household is currently experiencing homelessness or is at imminent risk of homelessness, as defined 24 CFR 91, 582 and 583, based on caseworker observations and certification and Applicant certification. (d) Notice of Eligibility Determination. Subrecipient shall provide written or documented verbal notice to each Applicant stating whether such Applicant was determined to be eligible for assistance under the TBRA Program. Applicants determined to be ineligible for TBRA Program assistance shall have an opportunity to appeal the determination to the Subrecipient's Executive Director. If the issue is not resolved, the case will be referred to the Deputy Director. The definition of"homelessness" 24 CFR 91, 582 and 583 is applicable to this Agreement. 1.4 Selection of Housing Units. (a) Housing Unit Selection. Subrecipient shall assist Eligible Households with finding and selecting an appropriate housing unit(each a"Housing Unit")that _ meets federal housing quality standards ("HQS") or such other standards as may be made applicable to the TBRA Program by HOME Program statutes and/or regulations, specifically including Uniform Physical Condition Standards (UPCS), and that satisfies the requirements of the TBRA Program, HOME Program and this Agreement. Eligible Households shall also be entitled to find a Housing Unit for themselves, subject to compliance with the requirements of the TBRA Program, HOME Program and this Agreement; however, the parties anticipate that in most cases, Subrecipient shall be responsible for locating and qualifying an appropriate Housing Unit for occupancy by each Eligible Household. Subrecipient may refer Eligible. Households to appropriate Housing Units but may not require an Eligible Household to select a particular Housing Unit. Subsidy Payments shall only be provided in connection with the rental of a qualified Housing Unit located in the City, unless Subrecipient documents reason for selecting housing outside the city. Subsidy Payments under this Agreement are portable within the City. Subrecipient's obligations under this Section 1.4 apply to each Housing Unit to be occupied by an Eligible Household receiving Subsidy Payments hereunder. (b) Housing Unit Size; Occupancy Standards. Housing unit selection shall comply with the following "Occupancy Standards"for the applicable Eligible Household: No more than two persons per bedroom plus one may occupy the Housing Unit. Thus, no more than three persons may occupy a one-bedroom 5 Housing Unit,no more than five persons may occupy a two-bedroom Housing Unit; no more than seven persons may occupy a three-bedroom Housing Unit; no more than nine persons may occupy a four-bedroom Housing Unit. (c) Property Inspection. Prior to occupancy of any Housing Unit by an Eligible Household, and again during the annual (or more often) verification process, Subrecipient shall cause a certified HQS inspector to inspect each Housing Unit occupied or to be occupied by an Eligible Household to ensure the Housing Unit complies with HQS as set forth in the HOME Program, including without limitation 24 CFR 92.251, as well as all applicable state and local codes and ordinances, including zoning ordinances. Subrecipient shall provide the City with documentation of each HQS inspector's certification. Each HQS inspection shall include all of the following: (i) Verification of the age of the Housing Unit (on Rent Reasonableness Form attached to the TBRA Program Operating Guidelines in Exhibit A; (ii) Complete HQS Inspection Checklist in the form attached to the TBRA Program Operating Guidelines in Exhibit A, including a rating for the Housing Unit of Pass,Pass with Comment,or Fail; (iii) Lead-based hazard assessment, dissemination of lead-based hazard information pamphlet and disclosure form and lead-based hazard reduction activities, if required by the HOME Program or applicable federal, state and/or local laws; (iv) Adequate opportunity for the Landlord (defined below) to correct any deficiencies indicated in the HQS Inspection Form to bring the Housing Unit into compliance with HQS requirements; (v) Verification that occupancy by the Eligible Household will comply with the Occupancy Standards set forth in Section 1.4(b); and (vi) Certification of rent reasonableness regarding the rent being charged for the Housing Unit based on comparable non-assisted Housing Units in the same area. Subrecipient shall perform the rent reasonableness review as approved by the City. City may elect to perform the rent reasonableness reviews on behalf of Subrecipient by providing written notice to Subrecipient. The rent charged under the written lease agreement for the Housing Unit shall conform to the Rent Reasonableness Standard pursuant to the TBRA Program Operating Guidelines in Exhibit A, which is based on local market conditions. The contract rent for Housing Units that are restricted to an affordable rent by agreement with the City or by regulation or ordinance, or otherwise, shall be likewise restricted to such affordable rent in accordance with the contractual, statutory or regulatory restrictions 6 governing the permitted rents for such Housing Units and the Rental Assistance Subsidy Payment shall be limited and calculated accordingly, as described in Section 1.5(a),below. (d) Coordination with Landlords. (i) Landlord Guidance. Subrecipient shall provide guidance to the property owners, property owners' representatives, or property management companies hired by property owners (each a "Landlord" and collectively referred to as "Landlords") participating in the TBRA Program regarding the TBRA Program requirements and procedures that impact Landlords. (ii) Landlord Agreement. Subrecipient shall enter into a Landlord Agreement with each .participating property owner/Landlord in substantially the form attached to the TBRA Program Operating Guidelines in Exhibit A. The Landlord Agreement will establish the Subsidy Payments to be made by Subrecipient on behalf of the Eligible Household as well as the Eligible Household's initial share of the contract rent. The Landlord Agreement shall further establish the terms and conditions under which the Subsidy Payments shall be paid to the Landlord for the applicable Housing Unit, including applicable HOME Program requirements. The Landlord Agreement shall have an initial term of 6-12 months, subject to extensions approved by Subrecipient and City (as applicable) pursuant to the TBRA Program Operating Guidelines. (iii) Tenant Protection Agreement. Subrecipient shall require each Landlord to enter into a lease agreement with a term of 12 months with any Eligible Household occupying a Housing Unit owned and/or managed by such Landlord, which lease agreement shall include a Tenant Protection Agreement in substantially the form attached to the TBRA Program Operating Guidelines in Exhibit A, or an updated form of Tenant Protection Agreement as may be prepared and. provided by the City to the Subrecipient, and then by Subrecipient to Landlord. The Tenant Protection Agreement shall be executed in connection with the lease agreement between the Landlord and Eligible Household. The Tenant Protection Agreement will prohibit the inclusion of prohibited lease terms listed at 24 CFR 92.253; Confirm the landlord's obligation to maintain the Housing Unit in accordance with HQS, as established at 24 CFR 982.401; and prohibit discrimination by the landlord against the Eligible Household. The Subrecipient will review the lease agreement to confirm its compliance with state law and all HOME Program requirements. If the Landlord's form of rental agreement is not acceptable, Subrecipient shall require the Landlord and Eligible Household to enter into a lease agreement 7 .that complies with state law, HOME requirements, and City requirements. 1.5 Subsidy Payments. Subrecipient shall make rent payments and security deposit payments, as applicable (collectively, the "Subsidy Payments"), to Landlords, on behalf of Eligible Households. Subsidy payments must be provided in accordance to the Subrecipient's TBRA Program Operating Guidelines. Eligible Households are not expected to repay Subsidy Payments received pursuant to the TBRA Program. Except as may be permitted by the HOME Program, Subrecipient' s sole remedy in the event of noncompliance or breach by an Eligible Household shall be non-renewal of assistance under the TBRA Program. (a) Rental Assistance Calculation. Subrecipient shall calculate the "Rental Assistance" payments to be paid on behalf of each Eligible Household under this Agreement. The maximum. amount of monthly assistance that the Subrecipient may pay on behalf of a family is the difference between the rent standard for the unit size and 30 percent of the household's monthly adjusted income. (b) Payment Standards. Subrecipient must use the payment standards as set forth in the Rent Reasonableness Standards attached to the TBRA Program Operating Guidelines in Exhibit A. The payment standards represent the cost of rent and utilities for moderately priced units in Huntington Beach. Payment standards are established by bedroom size. (c) Utility Allowance. When utilities are included in the cost of renting a unit, that is, the owner assumes responsibility for payment for all utility services, the Eligible Households entire share of the housing costs will go directly to the owner. When the cost of utilities is not part of the rent,that is,the Eligible Household is directly responsible for payment of utility services, the Eligible Household's initial share of monthly rent will be determined by subtracting a utility allowance from 30 percent of the Eligible Household's gross monthly income. The Subrecipient must use the County of Orange's Housing Authority's Utility Allowance Schedule attached to the TBRA Program Operating Guidelines in Exhibit A. (d) Term. The Subrecipient will provide rental assistance for an initial term of 6- 12 months, which can be extended in 6-12 month intervals, for a cumulative term of up to 24 months. Extensions will be granted at the discretion of the Subrecipient and shall be based on continued program compliance and ongoing need. The Subrecipient will evaluate ongoing need. (e) Security Deposit Assistance. Subrecipient may provide security deposit assistance to each Eligible Household. It is anticipated that Subrecipient shall provide Security Deposit Assistance to each Eligible Household in an amount no greater than two months' rent. The lease agreement must provide that the security deposit is refundable in accordance with state law. Security deposit 8 refunds shall be provided by the Landlord directly to the Eligible Household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by Eligible Household and landlord, as provided for in the lease. (f) Utility Deposit Assistance. 'Subrecipient may provide utility deposit assistance to each Eligible Household. It is anticipated that Subrecipient shall provide Security Deposit Assistance to each Eligible Household in an amount no greater than two months'rent. The lease agreement must provide that the security deposit is refundable in accordance with state law. Security deposit refunds shall be provided by the Landlord directly to the Eligible Household. Any disputes involving the return, or lack thereof,of a security deposit shall be settled by Eligible Household and landlord, as provided for in the lease. 1.6 Administrative Cost Reimbursements. The City will reimburse the Subrecipient for allowable costs incurred in administering the TBRA Program, which are associated with the determination of income eligibility, pursuant to 24 CFR 92.203, and property inspections under HQS, codified per 24 CFR 982. 401. Administrative costs incurred in administering the TBRA Program that are ineligible under the HOME Program will be reimbursed from a non-HOME Program funding source, or Community Development Block Grant(CDBG)Funds. The administrative costs to be reimbursed from the CDBG Funds include Intake Assessments,Housing Search, Case Management, Self—Sufficiency and related services and overhead. 1.7 Termination of Assistance and Returning Eligible Households. (a) Termination of Rental Assistance. Subrecipient may terminate assistance under the TBRA Program for any of the following reasons: (i) Eligible Household is evicted from the Housing Unit based on behavioral issues or unlawful activity; (ii) Eligible Household has violated TBRA participant agreement. (iii) Eligible Household will be assisted by another rental assistance program such as the Section 8 Tenant-Based or Project-Based Programs. Participation in any other rental assistance program is considered a duplicative subsidy therefore all HOME funded rental assistance must be terminated. 1.8 Returning Eligible Households. As needed,Eligible Households may be allowed to return to the program for rental assistance. A determination to allow re-entry shall be based on the following criteria: (i) Eligible Households must have left the program in good standing. To be in good standing, Eligible Households must have been engaged in their case management plan,voluntarily left the program(not in lieu of termination) or have been released because their household income 9 exceeded eligibility limits. In general, Eligible Households will not be allowed to re-enter the program if they were terminated for non- compliance. (ii) At the discretion of the Subrecipient, a request for re-admission from a • prospective Eligible Household previously terminated due to non- compliance may be considered when compelling reasons exist. In • such cases,re-admission will require concurrence from the City. (iii) Eligible Households may return so long as the previous rental assistance did not exceed 24 months. Cumulatively, Eligible Households may not receive rental advice for more than a cumulative period of 24 months unless such assistance is permitted by the HOME Program and approved by the City. 1.9 Additional Requirements. (a) Self-Sufficiency Program. Subrecipient shall request each Eligible Household receiving Subsidy Payments from the Subrecipient to participate in Housing Stabilization Case Management administered by Subrecipient and in accordance with the Case Management and Self Sufficiency Program Policies and Procedures attached to the TBRA Program Operating Guidelines in Exhibit A. Failure of an Eligible Household that is already receiving Subsidy Payments to participate in the Self-Sufficiency Program shall not be grounds for termination of the Subsidy Payments,but may be grounds for non-renewal of Subsidy Payments upon expiration of the subsidy term. (b) No Fees. Subrecipient may not charge fees to any Eligible Household for the Services, Subsidy Payments, Case Management or other services or assistance to be provided to Eligible Households under this Agreement. 1.10 Schedule of Performance. Subrecipient shall use its best efforts to perform the Services in accordance with the following schedule: (a) Affirmative marketing and outreach activities required by this Agreement shall commence immediately upon execution of this Agreement. (b) Subrecipient shall qualify Eligible Households, conduct HQS inspections, approve Housing Units, and move Eligible Households into approved Housing Units in accordance with the following milestone schedule: (i) Subrecipient shall process intake paperwork for and verify eligibility for TBRA Program assistance ("Enroll") for not fewer than three (3) Eligible Households within three (3) months following execution of this Agreement. As program income becomes available and/or additional HOME Funds are contributed to the TBRA Program, Subrecipient shall use diligent efforts to Enroll additional Eligible 10 Households within not more than three.(3) months following written notice from the City that such additional funds are expected to become available. (ii) Subrecipient shall assist each Enrolled Eligible Household in finding an appropriate Housing Unit and shall conduct an HQS inspection of • such Housing Unit, all within two (2) months following Enrollment of such Eligible Household. (iii) Subrecipient shall commence providing Subsidiary Payments on behalf of each Eligible Household and shall assist each Eligible Household to move into an HQS-inspected and approved Housing Unit, all within three (3) months following Enrollment/Intake of such Eligible Household. (c) Subrecipient shall request each Eligible Household to commence participation in the self-sufficiency program immediately upon Enrollment of such Eligible Household, whether or not such Eligible Household has yet moved into a Housing Unit and received the benefit of Subsidy Payments hereunder. 1.11 City Oversight and Approval Rights. City shall have the right, by written notice to Subrecipient at any time during the Term of this Agreement,to require City review of any of the Services to be performed or pre-approval of service tools and procedures by Subrecipient hereunder, including for example income determinations, qualification of applicants as " Eligible Households," qualification of Housing Units, determination of reasonable rents, etc., to ensure compliance with the TBRA Program,the HOME Program, or other applicable requirements. ARTICLE 2 TERM 2.1 Term. Services of the Subrecipient under this Agreement shall start on July 1, 2024 and end on the earlier to occur of(i).June 30, 2025 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) below has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets,including program income. ARTICLE 3 BUDGET AND PAYMENTS 3.1 Budget. Subrecipient has submitted a budget to City for approval ("Budget"), which sets forth the estimated timing and use of the HOME Funds contributed by the City pursuant to this Agreement. The Budget is attached hereto as outlined in the Scope of Services and Budget in Exhibit A. Any amendments to an approved Budget for the 11 Services must be approved by the Director or his authorized designee. In the event this Agreement is extended past the initial Term or any additional moneys will be contributed to the TBRA Program by City pursuant to this Agreement, Subrecipient shall prepare and submit to the Director for approval an updated Budget for such additional moneys. Subrecipient shall prepare a Budget, for approval by Director, for each year during which this Agreement remains in effect. The City may require a more detailed line item breakdown of the Budget than the one contained herein, and the Subrecipient shall provide such supplementary information about the Budget in a timely fashion in the form and content prescribed by the City. 3.2 Reimbursement of Subsidy Payments. City shall reimburse Subrecipient for Subsidy Payment actually disbursed to or on behalf of Eligible Households pursuant to this Agreement and in accordance with line items on the approved Budget or as otherwise approved by the Director. City shall have no obligation to reimburse Subrecipient for ineligible administrative costs or expenses incurred by Subrecipient to manage or implement the TBRA Program or this Agreement, for the cost of social or supportive services provided to Eligible Households hereunder, or for any other costs or expenses incurred by Subrecipient in connection with its activities under this Agreement. City's payment obligations hereunder shall be limited to the actual amount of Subsidy Payments disbursed by Subrecipient and eligible administrative costs in accordance with the terms of this Agreement and the approved Budget. Payments may be contingent upon certification of the Subrecipient's financial management system in accordance with the standards specified in 24 CFR 84.21. (a) Amount of Payments. It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed Two Hundred Thousand Dollars ($200,000.00). The dollar amounts stated in the immediately preceeding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of Subrecipient and the Director. (b) Requests for Payments. To receive each payment under this Agreement, Subrecipient shall submit to the City a written reimbursement request or invoice in a form approved by City, along with such supporting documentation as may be requested by the City to verify Subrecipient's performance of the Services for which the payment is requested. Reimbursement requests shall be submitted no more frequently than one time per month. Payments will be adjusted by the City in accordance with fund advances, if any, balances available in Subrecipient accounts. In addition,the City reserves the right to liquidate funds available under this Agreement for costs incurred by the City on behalf of the Subrecipient. 3.3 Payments Subject to Availability of HOME Funds. City's obligation to provide payments to Subrecipient hereunder is subject to City's receipt of HOME Funds from HUD pursuant to the HOME Program. 12 3.4 Accounting. Subrecipient shall, upon request, provide City with an accounting report, in form and content reasonably satisfactory to City, of any funds disbursed by City pursuant to Section 3.2. 3.5 Program Income. City and Subrecipient acknowledge and agree that the design of TBRA Program does not anticipate the receipt of"Program Income," as defined in 24 CFR 92.2, by the Subrecipient. Notwithstanding, in the event that any Program Income is received by the Subrecipient, Subrecipient will promptly remit same to the City. ARTICLE 4 INSURANCE AND INDEMNIFICATION 4.1 Insurance. Without limiting City's right to indemnification, Subrecipient shall secure prior to commencing the performance of any Services under this Agreement, and maintain during the Term of this Agreement, insurance coverage as set forth in this Section. (a) Required Insurance. Subrecipient shall secure and maintain the following coverage: Workers' Compensation Insurance as required by California statutes; (ii) Commercial General Liability Insurance, or Commercial General Liability Insurance, including coverage for Premises and Operations, Contractual Liability, Personal Injury Liability, Products/Completed Operations Liability, Broad-Form Property Damage, Independent Contractor's Liability and Fire Damage Legal Liability, in the amount of not less than One Million Dollars ($1,000,000.00) per occurrence, combined single limit,written on an occurrence form; and (iii) Comprehensive Automobile Liability coverage, including — as applicable - owned, non-owned and hire autos, in an amount of not less than One Million Dollars ($1,000,000.00) per occurrence, combined single-limit,written on an occurrence form. The Director, with the consent of City's Risk Manager is hereby authorized to modify the requirements set forth above in the event he or she determines that a modification, whether an increase or decrease, is in the City's best interest. (b) Required Clauses in Policies. Each insurance policy required by this Agreement shall contain the following clauses: "This insurance shall not be canceled or allowed to lapse without at least ten (10) day's prior written notice given to the City Clerk of the City of Huntington Beach,2000 Main Street,Huntington Beach,CA 92648." 13 "It is agreed that any insurance maintained by the City of Huntington Beach shall apply in excess of and not contribute with insurance provided by this policy." Each insurance policy required by this Agreement, excepting policies for workers' compensation, shall contain the following clause: "The City of Huntington Beach, its officials, agents, employees, representative, and volunteers are added as additional insureds as respects operations and activities of, or on behalf of the named insured, performed under contract with the City of Huntington Beach. Subrecipient hereby agrees to waive subrogation which any insurer of the Subrecipient may acquire from the Subrecipient by virtue of the payment of any loss. If requested by City, Subrecipient agrees to obtain and deliver to City any endorsement from Subrecipient's general liability and automobile insurance insurer to effect his waiver of subrogation. (c) Property Insurance. Subrecipient shall further comply with the insurance requirements of 24 CFR 94.31. - (d) Required Certificates and Endorsements. Prior to commencement of any Services under this Agreement, the Subrecipient shall deliver to City (i) insurance certificates confirming the existence of the insurance required by this Agreement, and including the applicable clauses referenced above, and (ii) endorsements to the above-required policies, which add to these policies the applicable clauses referenced above. Such endorsements shall be signed by an authorized representative of the insurance company and shall include the signator's company affiliation and title. Should it be deemed necessary by City, it shall be the Subrecipient's responsibility to see that City receives documentation, acceptable to City, which sustains that the individual signing such endorsements.is indeed authorized to do so by the insurance company. Also, City reserves the right at any time to demand, and to receive within a reasonable time period, certified copies of any insurance policies required under this Agreement, including endorsements effecting the coverage required by these specifications. (e) Remedies for Defaults Re: Insurance. In addition to any other remedies City may have if the Subrecipient fails to provide or maintain any insurance policies or policy endorsements to the extent and within the time herein required, City may, at its sole option: (i) Obtain such insurance and deduct and retain the amount of the premium for such insurance from any sums due under the Agreement; 14 (ii) Order the Subrecipient to stop work under this Agreement and/ or withhold any payment(s) which become due to the Subrecipient hereunder until the Subrecipient demonstrates compliance with the requirements hereof; or (iii) Terminate this Agreement. Exercise of any of the above remedies, however, is an alternative to other remedies City may have and is not the exclusive remedy for the Subrecipient's failure to maintain insurance or secure appropriate endorsements. Nothing herein contained shall be construed as limiting in any way the extent to which the Subrecipient may be held responsible for payment of damages to persons or property resulting from the Subrecipient's or its subcontractor's performance of the Services covered under this Agreement. 4.2 Indemnification. (a) As respects acts, errors or omissions in the performance of Services under this Agreement, the Subrecipient agrees to defend, indemnify and hold harmless City, its officers, agents, employees, representatives and volunteers from and against any and all claims, demands, defense costs, liability or consequential damages of any kind or nature arising directly out of the Subrecipient's negligent acts, errors or omissions in the performance of Services under the terms of this Agreement. (b) As respects all acts or omissions which do not arise directly out of the performance of Services, including but not limited to those acts or omissions normally covered by general and automobile liability insurance, Subrecipient agrees to indemnify, defend (at City's option), and hold harmless City, its officers, agents, employees, representatives, and volunteers from and against any and all claims, demands, defense costs, liability, or consequential damages of any kind or nature arising out of or in connection with Subrecipient's performance or failure to perform, under this Agreement; excepting those which arise out of the sole negligence of City. ARTICLE 5 ADMINISTRATIVE REQUIREMENTS 5.1 Financial Management. (a) Accounting Standards. Subrecipient agrees to comply with 24 CFR 84.21 through 84.28 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. 15 (b) Cost Principles. Subrecipient shall administer its program in conformance with OMB Circulars A-122, "Cost Principles for Non-Profit Organization." These principles shall be applied for all costs incurred whether charged on a direct or indirect basis. 5.2 Documentation, Recordkeeping, Reporting and Monitoring. Subrecipient shall maintain documents and records, prepare and submit reports, and permit City to monitor Subrecipient's activities all in accordance with the requirements set forth in Exhibit B and applicable laws and regulations. All requirements set forth in such Exhibit B are incorporated herein as if set forth in full in this Agreement. 5.3 Use and Reversion of Assets. The use and disposition of property and equipment under this Agreement shall be in compliance with the requirements of 24 CFR Part 84 and 24 CFT 92.504, as applicable. The Subrecipient shall transfer to the City any HOME Funds on hand and any accounts receivable attributable to the use of HOME Funds under this Agreement at the time of the earliest to occur of expiration, cancellation,or termination. 5.4 Ownership of Documents. All documents and materials, both tangible and intangible, furnished by or through the City to Subrecipient pursuant to this Agreement are and shall remain the property of City and shall be returned to City upon the earliest to occur of expiration, cancellation, or termination of this Agreement. All documents and materials prepared by Subrecipient under or related to this Agreement shall become the property of City at the time of payment to Subrecipient of all fees, if any,for their preparation, and shall be delivered to City by Subrecipient at the request of City, and in any event upon the earliest to occur of expiration,cancellation, or termination of this Agreement. 5.5 Record Retention. All TBRA Program records shall be maintained by the Subrecipient for a minimum of five (5) years beyond the final payment under this Agreement. Notwithstanding, if there are litigation, claims, audits, negotiations or other actions that involve any of the records cited and that have commenced before the expiration of the retention periods outlined, such records must be retained until completion of the actions and resolution of all issues, or the expiration of the retention period,whichever occurs later. ARTICLE 6 PERSONNEL &PARTICIPANT CONDITIONS 6.1 Civil Rights. (a) Compliance. The Subrecipient agrees to comply with the Huntington Beach Municipal Code, Government Code Section 4450, et seq., the Unruh Civil Rights Act, Civil Code Section 51, et seq., Title VI of the Civil Rights Act of 1964, as amended, Title VIII of the Civil Rights Act of 1968 as amended, Section 104(b) and Section 109 of Title 1 of the Housing and Community 16 Development Act of 1974, as amended, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, Executive Order 11063, and Executive Order 11246 as amended by Executive Orders 11375, 11478, 12107 and 12086. (b) Nondiscrimination. The Subrecipient agrees to comply with (1) the requirements of 24 CFR Part 5, subpart A, which relate to nondiscrimination and equal opportunity; (2) the nondiscrimination requirements of Section 282 of the HOME Investment Partnerships Act,42 U.S.C. Section 12701, et seq. (c) Section 504. The Subrecipient agrees to comply with all federal regulations issued pursuant to compliance with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), which prohibits discrimination against the individuals with disabilities or handicaps in any federally assisted program. 6.2 Affirmative Action. (a) Executive Order 11246. The Subrecipient agrees that it shall be committed to carry out pursuant to the City's specifications an Affirmative Action Program in keeping with the principles as provided in President's Executive Order 11246 of September 24, 1966. (b) Women- and Minority-Owned Businesses (W/MBE). The Subrecipient will use its best efforts to afford small businesses, minority business enterprises, and women's business enterprises the maximum practicable opportunity to participate in the performance of this Agreement. As used in this Agreement, the term "small business" means a business that meets the criteria set forth in Section 3(a) of the Small Business Act, as amended (15 U.S.C. 632), and "minority and women's business enterprise" means a business at least fifty-one percent (51%) owned and controlled by minority group members or women.'For the purpose of this definition, "minority group members" are Afro-Americans, Spanish-speaking, Spanish surnamed or Spanish-heritage Americans, Asian-Americans, and American Indians. The Subrecipient may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. (c) Equal Employment Opportunity and Affirmative Action (EEO/AA) Statement. The Subrecipient will, in all solicitations or advertisements for employees placed by or on behalf of the Subrecipient, state that it is an Equal Opportunity or Affirmative Action employer. (d) Subcontract Provisions. The Subrecipient will include the provisions of Sections 6.1, Civil Rights, and 6.2, Affirmative Action, in every subcontract or purchase order, specifically or by reference, so that such provisions will be binding upon each of its own sub-subrecipients or subcontractors. 17 6.3 Employment Restrictions. (a) Prohibited Activity. The Subrecipient is prohibited from using HOME Funds provided herein or personnel employed in the administration of the program for: political activities; inherently religious activities; lobbying; political patronage; and nepotism activities. (b) Labor Standard. The Subrecipient agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act (40 U.S.C. 327 et seq.) and all other applicable federal, state and local laws and regulations pertaining to labor standards insofar as and when those acts - apply to the performance of this Agreement. The Subrecipient agrees to comply with the Copeland Anti-Kick Back Act(18 U.S.C. 874 et seq.) and the implementing regulations thereto issued by the U.S. Department of Labor at 29 CFR Part 5. The Subrecipient shall maintain documentation that demonstrates compliance with applicable hour and wage requirements. (c) Prevailing Wage. The Subrecipient agrees that, to the extent applicable, all contractors engaged under contracts for construction, renovation or repair work financed in whole or in part with assistance provided under this Agreement shall comply with the regulations of the Department of Labor, under 29 CFR Parts 1, 3, 5 and 7 and California Labor Code Section 1720, et seq. governing the payment of wages and ratio of apprentices and trainees to journey workers. The Subrecipient shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. (d) Section 3 Clause. The Subrecipient agrees, to the extent applicable, to comply with Section 3 of the HUD Act of 1968, as amended, and as implemented by the regulations set forth in 24 CFR,135. 6.4 Conduct. (a) Assignment. The Subrecipient shall not assign or transfer any interest in this Agreement without the prior written consent of the City thereto; provided, however, that claims for money due or to become due to the Subrecipient from the City under this Agreement may be assigned to a bank, trust company, or other financial institution without such approval. Notice of any such assignment or transfer shall be furnished promptly to the City. (b) Subcontracts. (i) Approvals. The Subrecipient shall not enter into any subcontracts with any entity, agency or individual in the performance of this Agreement 18 without the written consent of the City prior to the execution of such agreement. (ii) Monitoring. The Subrecipient will monitor all subcontracted services on a regular basis to assure contract compliance. Results of monitoring efforts shall be summarized in written reports and supported with documented evidence of follow-up actions taken to correct areas of noncompliance. (iii) Content. The Subrecipient shall cause all of the provisions of this Agreement in its entirety to be included in and made a part of any subcontract executed in the performance of this Agreement. (iv) Selection Process. The Subrecipient shall undertake to insure that all subcontracts let in the performance of this Agreement shall be awarded on a fair and open competition basis in accordance with applicable procurement requirements. Executed copies of all subcontracts shall be forwarded to the City along with documentation concerning the selection process. (c) Hatch Act. The Subrecipient agrees that no funds provided, nor personnel employed under this Agreement, shall be in any way or to any extent engaged in the conduct of political activities in violation of Chapter 15 of Title V of the U.S.C. (d) Conflict of Interest. The Subrecipient agrees to abide by the provisions of 24 CFR 84.42 and 92.356, which include (but are not limited to) the following: (i) The Subrecipient shall maintain a written code or standards of conduct that shall govern the performance of its officers. employees or agents engaged in the award and administration of contracts supported by HOME Funds. (ii) No employee, officer or agent of the Subrecipient shall participate in the selection, or in the award, or administration of, a contract supported by HOME Funds if a conflict of interest, real or apparent, would be involved. (iii) No covered persons who exercise or have exercised any functions or responsibilities with respect to HOME-assisted activities, or who are in a position to participate in a decision-making process or gain inside information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the HOME-assisted activity, or with respect to the proceeds from the HOME-assisted activity, either for themselves or those with whom they have business or 19 immediate family ties, during their tenure or for a period of one (1) year thereafter. For purposes of this paragraph, a "covered person" includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the City, the Subrecipient, or any designated public agency. (e) Lobbying. The Subrecipient hereby certifies that: (i) No federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal 1 oan, the entering into of any.cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement; (ii) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, it will complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions;and (iii) It will require that the language of paragraph (iv) of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all Subrecipients shall certify and disclose accordingly. (f) Lobbying Certification. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352 Title 31, U.S.C. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. (g) Religious Activities. The Subrecipient agrees that funds provided under this Agreement will not be utilized for inherently religious activities such as worship,religious instruction,or proselytization. (h) Drug-Free Workplace. The Subrecipient agrees to maintain a drug-free workplace per the requirements of 2 CFR part 2429. 20 (i) Debarred or Suspended Entities. By signing this Agreement, Subrecipient certifies that it is not presently listed by any federal agency as debarred, suspended, or proposed for debarment from any federal contract activity. If during the term of this Agreement this information changes, Subrecipient shall notify City without delay. Such notice shall contain all relevant particulars of any debarment, suspension, or proposed debarment. Further, in carrying out its responsibilities hereunder, Subrecipient will not employ, contract with, or otherwise make use of subcontractors, service providers, consultants, or any other party that is debarred, suspended, or proposed for debarment from any federal contract activity. (j) VAWA Regulations. The City and Subrecipient both acknowledge and agree • that each are subject to the requirements of 24 CFR 92.359 and 24 CFR 5, Subpart L, which implements provisions of the Violence Against Women Reauthorization Act of 2013 (VAWA). Subrecipient also agrees to follow and implement the applicable VAWA requirements contained in the City's Program Guidelines and the City's Emergency Transfer Plan, as required by 24 CFR 92.359(g), for all applicants to the TBRA Program, and all TBRA recipients for the period that tenant based rental assistance is provided. Moreover, the Subrecipient agrees that all leases that are approved by the Subrecipient shall contain the City's required VAWA lease term/addendum, as described in 24 CFR 92.359(e) and the City's TBRA Program(Exhibit A). ARTICLE 7 GENERAL CONDITIONS 7.1 General Compliance. The Subrecipient agrees to comply with the requirements of the HOME Program in the administration and implementation of the TBRA Program and this Agreement. The Subrecipient shall carry out each activity in compliance with all regulations described in subpart H of 24 CFR Part 92, except that the Subrecipient does not assume the City's responsibilities for environmental review under 24 CPR 92.352 and the intergovernmental review process described in 24 CFR 92.357 does not apply to the Subrecipient. The Subrecipient also agrees to comply with all other applicable federal, state and local laws, regulations, and policies governing the funds provided under this Agreement. The Subrecipient further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available. 7.2 Familiarity with Services;Qualified Personnel. (a) By executing this Agreement, Subrecipient represents and warrants that Subrecipient (i) has thoroughly investigated and considered the Services to be performed, (ii) has carefully considered how the Services should be performed, and (iii) fully understands the requirements, difficulties and restrictions attending the performance of the Services under this Agreement. (b) Subrecipient represents that Subrecipient has or will secure and maintain, at 21 Subrecipient's sole cost and expense, all qualified and licensed personnel required to perform the Services. Staff and any additional personnel hired by Subrecipient shall be employees of Subrecipient. Such personnel shall not be deemed to be employees of City or to have any contractual relationship with City. Such Personnel shall be authorized or permitted under state and local law to perform the Services. 7.3 Independent Contractor. In performing under this Agreement, Subrecipient is and shall at all times be acting and performing as an independent contractor to City, performing its duties in accordance with its own judgment. City shall neither have nor exercise any control or direction over the methods by which Subrecipient performs its work and function nor shall City have the right to interfere with such freedom or action or prescribe rules or otherwise control or direct the manner in which such services are performed. The sole interest of the City in the Services performed by the Subrecipient is that such Services be performed in a legal competent, efficient and satisfactory manner. Nothing contained herein shall cause the relationship between the parties to this Agreement to be that of employer and employee. Subrecipient shall not have the authority to obligate City to any contract, obligation, or undertaking whatsoever and shall make no representation, either oral or in writing. 7.4 Subrecipient Representative. Subrecipient hereby designates Madelynn Hirneise as its Project Manager for the TBRA Program ("Subrecipient's Representative"). Subrecipient's Representative shall supervise and direct the Services, using his or her best skill and attention, and shall be responsible for all means, methods, techniques, sequences and procedures and for the satisfactory coordination of all portions of the Services under this Agreement. 7.5 Nepotism. Subrecipient shall not hire or permit the hiring of any person to fill a position funded through this Agreement if a member of the person's immediate family is employed in an administrative capacity by City's HOME Program or any department of the City which is administering the HOME Program. For the purposes of this section, the term "immediate• family means spouse, child, mother, father brother, sister, brother-in-law, sister-in-law, father-in-law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, stepparent and stepchild. The term "administrative capacity" means having selection, hiring, supervisory or management responsibilities, including serving on the governing body of City. 7.6 Hold Harmless. The Subrecipient shall indemnify, hold harmless, and defend the City and their elected officials, officers, employees and agents and shall pay for expenses incurred by the City for any and all claims, actions, suits, charges and judgments whatsoever related in any manner to or that arise out of the Subrecipient's performance or nonperformance of the Services or subject matter called for in this Agreement. 7.7 City Recognition. The Subrecipient shall insure recognition of the role of the City in providing Services through this Agreement. All activities, facilities and items utilized pursuant to this Agreement shall be prominently labeled as to funding source. 22 7.8 Notices. Any approval, disapproval, demand, document or other notice ("Notice") which any party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by reputable document delivery service such as Federal Express that provides a receipt showing date and time of delivery, (iii) facsimile transmission, or (vi) mailing in the United States mail, certified mail,postage prepaid, return receipt requested, addressed to the address of the party as set forth below, or at any other address as that party may later designate by Notice. Service shall be deemed conclusively made at the time of service if personally served; upon confirmation of receipt if sent by facsimile transmission; the next business if sent by overnight courier and receipt is confirmed by the signature of an agent or employee of the party served; the next business day 'after deposit in the United States mail, properly addressed and postage prepaid, return receipt requested, if served by express mail; and three (3) days after deposit in the United States mail, properly addressed and postage prepaid, return receipt requested, if served by certified mail. Subrecipient: Madelyn Hirneise Project Manager Families Forward 8 Thomas Irvine, CA 92618 City: City Clerk City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 With copies to: Steve Holtz,Deputy Director Community Development/NED 2000 Main Street Huntington Beach, CA 92648 Such addresses may be changed by Notice to the other party(ies) given in the same manner as provided above. 7.9 Amendment and Waiver. This Agreement may be amended, modified, or supplemented only by a writing executed by each of the parties. Any party may in writing waive any provision of this Agreement to the extent such provision is for the benefit of the waiving party. No action taken pursuant to this Agreement, including any investigation by or on behalf of any party, shall be deemed to constitute a waiver by that party or its or any other party's compliance with any representations or warranties or with any provision of this Agreement. 23 7.10 Entire Agreement. This Agreement, including all Exhibits attached hereto, embodies the entire agreement and understanding between the parties pertaining to the subject matter of this Agreement and supersedes all prior agreements, understandings, negotiations, representations, and discussions, whether verbal or written, of the parties pertaining to the subject matter. In the event of a conflict between this Agreement, on one hand, and any Exhibit attached hereto, on the other hand, the provisions of this Agreement shall control; provided, if it is possible to comply with the requirements of this Agreement and the Exhibits, the parties shall do so. The following Exhibits are attached to this Agreement and incorporated herein: Exhibit A Scope of Services and Budget and TBRA Program Operating Guidelines Exhibit B Documentation,Recordkeeping,Reporting and Monitoring Requirements Exhibit C Gross Income Calculation Form Exhibit D Household Budget Worksheet Exhibit E Lead-Based Hazard Information Pamphlet"Protect Your Family from Lead in your Home" 7.11 Governing Law. The validity, construction, and performance of this Agreement shall be governed by the laws of the State of California. 7.12 Non-Liability of Members, Officials and Employees of City. No member, official or employee of City shall be personally liable to Subrecipient, or any successor in interest, in the event of any Default or breach by City or for any amount which may become due to Subrecipient or Subrecipient's successors, or on any obligation under the terms of this Agreement. Subrecipient hereby waives and releases any claim Subrecipient may have against the member, officials or employees of City with respect to any Default or breach by City or for any amount which may become due to Subrecipient or Subrecipient's successors, or any obligations under the terms of this Agreement. Subrecipient makes such release with the full knowledge of Civil Code Section 1542 and hereby waives any and all rights thereunder to the extent of this release, if such Section 1542 is applicable. Section 1542 of the Civil Code provides as follows: "A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE,WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR." 24 ARTICLE 8 ENFORCEMENT; TERNIINATION 8.1 Events of Default. (a) For purposes of this Agreement, the word "Default" shall mean the failure of Subrecipient to perform any of Subrecipient's duties or obligations or the breach by, Subrecipient of any of the terms and conditions set forth in this Agreement; any failure by Subrecipient to comply with any of the rules, regulations or provisions referred to herein, or such statutes, regulations, executive orders, and HUD guidelines,policies or directives as may become applicable at any time; any ineffective or improper use of funds provided under this Agreement; or submission by the Subrecipient to the City reports that are incorrect or incomplete in any material respect. In addition, Subrecipient shall be deemed to be in Default upon Subrecipient's (i) application for, consent to, or suffering of, the appointment of a receiver, trustee or liquidator for all or a substantial portion of its assets, (ii)making a general assignment for the benefit of creditors, (iii) being adjudged bankrupt, (iv) filing a voluntary petition or suffering an involuntary petition under any bankruptcy, arrangement, reorganization or insolvency law (unless in the case of an involuntary petition, the same is dismissed within thirty (30) days of such filing), or (v) suffering or permitting to continue unstayed and in effect for fifteen (15) consecutive days any attachment, levy, execution or seizure of all or a substantial portion of Subrecipient's assets or of Subrecipient's interests hereunder. (b) City shall not be deemed to be in Default in the performance of any obligation required to be performed by City hereunder unless and until City has failed to perform such obligation for a period of thirty (30) days after receipt of written notice from Subrecipient specifying in reasonable detail the nature and extent of any such failure; provided, however, that if the nature of City's obligation is such that more than thirty (30) days are. required for its performance, then City shall not be deemed to be in Default if City shall commence to cure such performance within such thirty(30) day period and thereafter diligently prosecute the same to completion. 8.2 Institution of Legal Actions. In addition to any other rights and remedies, and subject to the restrictions otherwise set forth in this Agreement, either party may institute an action at law or in equity to seek the specific performance of the terms of this Agreement, to cure, correct or remedy any Default, to recover damages for 25 any Default or to obtain any other remedy consistent with the purpose of this Agreement. Such legal actions must be instituted in the Superior Court of the County of Orange, State of California or in the United States District Court for the Central District of California. 8.3 Acceptance of Service of Process. In the event that any legal action is commenced by the Subrecipient against City, service of process on City shall be made by personal service upon the City Clerk or in such other manner as may be provided by law. In the event that any legal action is commenced by City against the Subrecipient, service of process on the Subrecipient shall be made by personal service upon Subrecipient's Representative or in such other manner as may be provided by law. 8.4 Rights and Remedies Are Cumulative. Except as otherwise expressly stated in this Agreement, the rights and remedies of the parties are cumulative, and the exercise by either party of one or more of such rights or remedies shall not preclude'the exercise by it, at the same or different times, of any other rights or remedies for the same Default or any other Default by the other party. 8.5 Inaction Not a Waiver of Default. Any failures or delays by either party in asserting any of its rights and remedies as to any Default shall not operate as a waiver of any Default or of any such rights or remedies, or deprive either such party of its right to institute and maintain any actions or proceedings which it may deem necessary to protect, assert or enforce any such rights or remedies. 8.6 Attorney's Fees. City and Subrecipient agree that in the event of litigation to enforce this Agreement or terms, provisions and conditions contained herein, to terminate this Agreement, or to collect damages for a Default hereunder, the prevailing party shall not be entitled to costs and expenses, including reasonable attorney's fees, incurred in connection with such litigation, such that each party shall be responsible for their costs and attorneys' fees. 8.7 Termination. (a) Termination for Cause. In accordance with 24 CFR 85.43, the City may suspend or terminate this Agreement in the event of a Default by the Subrecipient under this Agreement. Subrecipient may suspend or terminate this Agreement if City fails to make payments to Subrecipient as required herein. (b) Termination for Convenience. In accordance with 24 CFR 85.44, this Agreement may also be terminated for convenience by either the City or the Subrecipient, in whole or in part, by setting forth the reasons for such termination, the date the termination will be effective, and, in the case of partial termination, the portion to be terminated. However, if in the case of a partial termination, the City determines that the remaining portion of the award will not accomplish the purpose for which the award was made, the City may terminate the award in its entirety. 26 IN WITNESS WHEREOF, the parties have executed this HOME Subrecipient Agreement (Tenant Based Rental Assistance) as of the Effective Date, which is the date of the City Council approving this Agreement. SUBRECIPIENT: CITY: FAMILIES FORWARD, CITY OF HUNTINGTON BEACH, a California nonprofit corporation a municipal corpora ' n an harter city By:4Y\alac ,K, W-KPLISJ • Moldel V1Y1 'St- City Manager print name ITS: Executive Director ATTEST: AND By: , City Jerk By: q/1:14-- l6-97)-2214/16 �Y1 Ga P,-e/r6OS APPROVE S RM: print name ITS: (circle one)Secretary/ By: (Chief Financial Officer sst. Secretary—Treasurer City Attorney ILL ITIATED AND PPROVED: By: / V tr c r of Community Development REVIEWED AND APPR VED: By: Assistant City anager 27 • Exhibit A j • Scope of Services and Budget V Program Guidelines/Operating Procedures EXHIBIT A FY 2024-25 HOME TENANT BASED RENTAL ASSISTANCE (TBRA) SCOPE OF SERVICES AND BUDGET FAMILIES FORWARD A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing Insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2024 and June 30, 2025, Families Forward will: 1. Provide rental assistance subsidies,security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) Inspections and Income eligibility reviews to 15 Huntington Beach households in accordance with the TBRA Guidelines. Families Forward will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Families Forward will be reimbursed on a monthly basis In accordance with the following annual project budget: Tenant Based Rental Assistance: $140,000 Security Deposit: 45,000 HSQ Inspection: 7,500 Income Certification: 7,500 Total Families Forward Budget: $200,000 EXHIBIT A CITY OF HUNTINGTON BEACH TENANT BASED RENTAL ASSISTANCE PROGRAM PROGRAM GUIDELINES/OPERATING PROCEDURES (July 2024) 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.) II. 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, 0C211 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. 1 • Proof that an adult member of the household is working or has been recently hired to work in Huntington Beach. 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 2 received prospectively during the 12-month period following the date of application and before any deductions are taken. • 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. • 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. 3 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: • 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 Number in Unit Type Household One-bedroom Unit U• to 3 Persons Two-bedroom Unit U• to 5 Persons Three-bedroom Unit U• to 7 Persons Four-bedroom Unit U• 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); 5 • The quality of the unit,which includes the building construction,maintenance and improvements; and • 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; 6 • • (2) Treatment of property; • (3) Excusing owner from responsibility; • (4) Waiver of notice; • (5) Waiver of legal proceedings; • (6) Waiver of a jury trial; • (7) Waiver of right to appeal court decision; • (8) Tenant chargeable with cost of legal actions regardless of outcome; and • (9) Mandatory supportive services. ■ Confirm the landlord's obligation to maintain the Housing Unit in accordance with HQS,as established at 24 CFR 982.401. • 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. 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). 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 I) 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. i. 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 • 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. VI. 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 I) 9 VII. Annual Recertification, Termination of Assistance and Returning Households A. Annual Recertification Recertification of income and Program eligibility will every 6 months. The Service Provider will gather source documentation for participating households to determine annual income. Annual income must be calculated in accordance with 24 CFR Part 5. If the total household income is above 80%AMI,rental assistance must be terminated following a 30 day notification period. B. Termination of Rental Assistance Assistance can be terminated for the following reasons: ■ Eviction from the assisted rental unit based on behavioral issues and/or unlawful activity. ■ The family will be assisted by another rental assistance program such as the Section 8 Tenant-Based or Project-Based program. Participation in any other rental assistance program is considered a duplicative subsidy therefore all HOME funded rental assistance must terminate. • Failure to meet significant goals in the participants Self-Sufficiency Program as outlined on page 11, Case Management. 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. 10 Self Sufficiency Program Subrecipient will request each Eligible Household receiving rental assistance payments to participate in a Self-Sufficiency Program administered by Subrecipient. The Case Management and Self-Sufficiency Program Policies and Procedures are outlined in Appendix J. The Self-Sufficiency Program provides participating households with intense case management,which is designed to assist participants move to self-sufficiency within a 12 to 24-month period. Income recertifications will be completed annually for participating households. If the participating household's income exceeds the low (80%AMI) income limits,Subrecipient must terminate the rental assistance. Listed below are some of the Self-Sufficiency Case Management Services offered by Subrecipient: D. Case Management The Subrecipient Case Management model maximizes client success by developing individualized service plans and addressing clients' specific needs in securing permanent housing and self-sufficiency. Clients will meet with their Case Manger on a minimum of a monthly basis to update goals, monitor progress, and ensure long- term housing stability. Self-sufficiency groups are also held weekly to assist with financial management, job development, life skills, personal empowerment, and accessing other resources needed to gain housing stability. E. Individualized Housing and Service Plan Participants meet with their Case Manager at intake and monthly to review their Goal Worksheet and Individualized Service Plan to help establish and identify participant goals and plans for housing, education, employment, financial (including budgeting and credit repair), legal, and other housing stabilization and relocation resources needed. F. Housing Search and Placement Subrecipient advocates assists clients with comprehensive housing search and placement into affordable permanent housing. Subrecipient has established close partnerships with permanent housing agencies, including affordable housing providers,apartment associations,and private landlords/owners. G. Financial Management/Credit Repair Subrecipient assists program participants with credit repair, financial literacy, and job placement and retention. Assistance will also be provided to access mainstream financial benefits including social security, veteran's benefits, Ca1WORKs, disability, unemployment, and other public assistance. 11 • H. Employment Assistance Obtaining self-sufficiency is a critical goal for families served by Subrecipient. Subrecipient Case Managers work with clients to identify interests, life experiences and talents that lend themselves to employment. Housing Advocates also: • Help clients develop resumes,complete job application and prepare for interviews; • Obtain educational scholarships through AmeriCorps and other sources to increase leadership skills and/or further their education; • Provide transportation solutions to job interviews and job-related activities; and • Provide job placement in career-level jobs and job retention assistance. I. Transportation Subrecipient provides support services at Community Service Center and Satellite sites in Huntington Beach conveniently accessible via public transportation routes or via home visits as needed. Subrecipient provides assistance with transportation via bus passes and accessing mainstream resources available for transportation through Ca1WORKs and disability access. Subrecipient also maintains agreements with local taxi companies to provide emergency transportation assistance and works closely with the Huntington Beach Police Department to assist transport participants in crisis situations. J. Behavioral Health Subrecipient provides an array of individual and group counseling programs on-site and works closely with other mental health providers to address behavioral health needs of participants. VIII. 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. 12 IX. CITY REQUIREMENTS A. Monthly Meetings and Reports Each month,the 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. Monthly Summaries At the end of each month, 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 20 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. 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/Operating 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 K.) 13 As applicable,the City and Service Providers shall both implement the requirements regulations of the Violence Against Women Reauthorization Act of 2013 (VAWA) per the provisions outlined in 24 CFR 92.359 and 24 CFR 5,Subpart L. Service Providers shall also implement the applicable VAWA requirements related to the City's Emergency Transfer Plan,as required by 24 CFR 92.359(g) and included as Appendix K, for all applicants to the TBRA Program,and all TBRA recipients for the period that tenant based rental assistance is provided. Moreover,all leases that are approved by the Service Providers shall contain the City's required VAWA lease term/addendum per 24 CFR 92.359(e),and included as Appendix L. 14 Exhibit A - Appendix A Sample TBRA Application (Pre-Application) FAMILY SERVICE REQUEST FORM Are you a family who is currently experiencing homelessness or at risk for becoming homeless? Please complete the Family Service Request form below and the information will be directed via e-mail to a direct service provider at your nearest Family Access Point(location where a family receives support and referrals to appropriate housing options). Families will be screened for eligible and available services. Access Points are not emergency services.Please allow up to three(3)business days for an Access Point to contact you after submission of the Family Service Request form.(Please note the FSC is not a direct service provider,you will be contacted by your nearest Family Access Point.) P/ease be sure to check your email's spam folder when submitting this form if you have not received a confirmation. English Terms * By submitting this online form,I give permission to share my information contained in this form with the Family Solutions Collaborative and Family Access Points. This form and its data will be sent via email to a Family Access Point Staff at a Family Access Point.I understand that the submission of this form does not guarantee services or financial assistance,and that I may receive assistance from a similar or comparable program.I certify that the information I provide on this form is true, correct and complete. (� I agree O I do not agree Eligibility Are you currently experiencing a health or physical safety emergency? * O Yes O No Are you currently residing/staying in Orange County,CA? * O Yes O No City * What is your Irvine zip code? * V Are you,or is anyone in your household,a Veteran of the U.S.Military(any discharge status)? * O Yes O No O Do not know O Decline to answer What type of insurance do you have? * O Medi-Cal O My own insurance(not Medi-Cal) O None Terms * I hereby authorize the FSC to use my medical insurance status with FSC partner agencies assisting in obtaining coverage. O Iconsent O I do not consent Is anyone in the family currently pregnant? * O Yes O No Do you have any minor children in your care? O Yes O No How many minor children(17 or younger)are in your household,including those that you may be in the process of reuniting with? * O ° O 1 O 2 O 3 O 4 O 5 or more Including you,how many people in your household are 18 or older? * O 1 O 2 O 3 O 4 O 5 or more Head of Household Information Name * First Last Gender * O Female O Male Q A gender other than singularly female or male(e.g.,non-binary,genderfluid,agender,culturally specific gender) • Transgender O Questioning O Do not know Q Decline to answer Race/Ethnicity * Q American Indian,Alaska Native,or Indigenous Q Asian or Asian American O Black,African American,or African • Hispanic/Latin(a)(o)(x) Q Middle Eastern or North African Q Native Hawaiian or Pacific Islander Q White Q Multi-racial Q Do not know Q Prefer not to answer Primary Language * Q English Q Spanish Q Vietnamese Q American Sign Language Q Other • Where did you stay last night? * O Outdoors,in a vehicle,abandoned building,garage/shed or park O An emergency shelter or motel paid by an agency/church O Institutional setting(hospital,jail,sober living,rehab center) O A motel paid for by myself,or friends/family O With family or friends(home,apartment,dorm) O In our own rental apartment or house Primary Phone Number * Alternate Phone Number Email Enter Email Confirm Email When is the best time to reach you? Select all that apply n 8am-11am • 11am-2pm O 2pm-5pm Would you like to receive an email confirmation that this form has been successfully submitted to an Access Point? * Q Yes O No Exhibit A - Appendix B Sample TBRA Application (Full-Application) FY 2024 OC HMIS: PROJECT INTAKE FORM — GENERAL & CoC/ESG CLIENT PROFILE SOCIAL SECURITY NUMBER(SSN) — — QUALITY OF SSN-Only required to collect the last four digits of the SSN,though are not prohibited from collecting all nine digits for new client records. Full SSN reported Approximate or partial Client doesn't know Client prefers not to Data not collected SSN reported answer CLIENT'S NAME N/A Last First Middle Suffix QUALITY OF NAME Full name -- Partial,street name,or code Client doesn't know Client prefers Data not collected reported name reported not to answer DATE OF BIRTH — — Age: Month Day Year QUALITY OF DOB Full DOB reported Approximate or Client doesn't know Client prefers not to Data not collected partial DOB reported answer GENDER(Select all that apply) ❑Woman(Girl if child) ❑Transgender ❑Client doesn't know ❑Questioning ❑ Man (Boy if child) ❑Culturally Specific Identity(e.g., Two Spirit) El Client prefers not to answer ❑ Non-Binary ❑Different Identity ❑ Data not collected If'Different Identity' Please Specify RACE AND ETHNICITY(Select all that apply) ❑American Indian,Alaska Native,or ❑ Hispanic/Latina/e/o Indigenous ❑Client doesn't know ❑ Middle Eastern or North African ❑Asian or Asian American ❑ Client prefers not to answer ❑ Black,African American,or African El Native Hawaiian or Pacific Islander ❑ Data not collected ❑White VETERAN STATUS ❑Client doesn't know No ❑Client prefers not to answer J Yes(If marked Yes,complete HMIS Veteran Form) ❑ Data not collected OC OPTIONAL QUESTIONS Alias Pronouns(s) ❑She/Her/Hers CIThey/Them/Theirs ❑ He/Him/His ❑Other: 1 Revised 10/01/2023 FY 2024 OC HMIS: PROJECT INTAKE FORM — GENERAL & CoC/ESG PROJECT ENROLLMENT TRANSLATION ASSISTANCE NEEDED ❑Client doesn't know No ❑Client prefers not to answer Yes ❑ Data not collected Preferred Language ❑Spanish ❑ Farsi ❑Vietnamese ❑Arabic E Chinese ❑ Russian E Client doesn't know ❑Cantonese ❑French ❑Client prefers not to answer E Mandarin ❑ Ukrainian ❑ Data not collected ❑Korean ❑Different Preferred Language ❑Persian If Different Preferred Language Please Specify RELATIONSHIP TO HEAD OF HOUSEHOLD ❑Self(head of household) ❑ Head of household's child ❑ Head of household's other relation member ❑ Head of household's spouse or partner ❑Other: non-relation member PROJECT NAME PROJECT START DATE — — HOUSING MOVE-IN DATE (For PSH, PH with no disability requirement, and RRH — — Projects:Record the date a client or household moves into a permanent housing unit) 2 Revised 10/01/2023 FY 2024 OC HMIS: PROJECT INTAKE FORM — GENERAL & CoC/ESG PRIOR LIVING SITUATION for project types other than Street Outreach, Emergency Shelter, or Safe Haven Type of Residence 3.917B (Type of living arrangement on the night before the entry into the project) HOMELESS SITUATION Place not meant for habitation (e.g., a vehicle, an abandoned building, bus/train/subway station/airport or anywhere outside) Emergency shelter, including hotel or motel paid for with emergency shelter voucher,or RHY-funded Host Home shelter Safe Haven INSTITUTIONAL SITUATION Foster care home or foster care group home Long-term care facility or nursing home Hospital or other residential non-psychiatric medical facility Psychiatric hospital or other psychiatric facility Jail, prison or juvenile detention facility Substance abuse treatment facility or detox center TRANSITIONAL HOUSING SITUATION ❑Transitional housing for homeless persons(including ❑ Staying or living in a friend's room, apartment,or house homeless youth) ❑Staying or living in a family member's room, apartment, or ❑ Residential project or halfway house with no homeless criteria house ❑ Hotel or motel paid for without emergency shelter voucher ❑ Host Home(non-crisis) PERMANENT HOUSING SITUATION ❑ Rental by client, no ongoing housing subsidy ❑Client doesn't know ❑Rental by client,with ongoing housing subsidy ❑ Client prefers not to answer ❑Owned by client, with ongoing housing subsidy ❑ Data not collected ❑Owned by client, no ongoing housing subsidy Rental Subsidy Type if Rental by client,with ongoing housing subsidy ❑GPD TIP housing subsidy ❑ Rental by client,with other ongoing housing subsidy ❑VASH housing subsidy ❑ Housing Stability Voucher ❑ RRH or equivalent subsidy ❑ Family Unification Program Voucher(FUP) ❑ HCV voucher(tenant or project based) (not dedicated) ❑ Foster Youth to Independence Initiative(FYI) ❑ Public housing unit ❑ Permanent Supportive Housing ❑ Other permanent housing dedicated for formerly homeless persons Length of Stay in Prior Living Situation (How long ago did the client start staying in that Type of Residence) ❑One night or less ❑One month or more, but less than 90 days Client doesn't know ❑Two to six nights ❑90 days or more, but less than one year Client prefers not to ❑One week or more, but less than one month ❑ One year or longer answer Data not collected If Client's Type of Residence is any of the Homeless Situation options: Approximate Date Homelessness Started (Approximate date the client's current episode of homelessness began) / / Number of times the client has been on the streets, in ES,or Save Haven in the past three years including today (Regardless of where they stayed last night) ❑ One time ❑Three times Client doesn't know ❑Two times ❑ Four or more times Client prefers not to answer Data not collected Total number of months homeless on the streets, in ES,or SH in the past three years 3 Revised 10/01/2023 FY 2024 OC HMIS: PROJECT INTAKE FORM — GENERAL & CoC/ESG ❑One month(this time is the first month) ❑Six Months ❑ Eleven Months ❑Two Months ❑Seven Months El Twelve Months ❑Three Months ❑ Eight Months ❑More than 12 months ❑ Four Months ❑ Nine Months ❑Client doesn't know ❑ Five Months ❑Ten Months ❑Client prefers not to answer ❑Data not collected If Client's Type of Residence is any of the Institutional Situation options: Length of Stay Less than 90 days? (Indicate if the stay in the institutional setting they lived in immediately prior to project entry was No - Yes less than 90 days) If Client's Type of Residence is any of the Transitional and Permanent Housing Situation options: Length of Stay Less than 7 nights? (Indicate if the stay in the transitional or permanent housing setting they lived in immediately prior No Yes to project entry was less than 7 nights) If'Length of Stay Less than 90 days' is YES—OR— If'Length of Stay Less than 7 nights' is YES On the night before—stayed on streets, ES or Safe Haven? (On the night before the client's stay of less than 90 days in an institutional setting, or less than 7 No Yes nights in a transitional/permanent housing setting, were they on the streets, in an Emergency Shelter, or in a Safe Haven?) If'On the night before—stayed on streets, ES, or Safe Haven' is YES Approximate Date Homelessness Started (Approximate date the client's current episode of homelessness began) I I Number of times the client has been on the streets, in ES,or Save Haven in the past three years including today (Regardless of where they stayed last night) ❑One time In Three times Client doesn't know ❑Two times ❑ Four or more times Client prefers not to answer Data not collected Total number of months homeless on the streets,in ES,or SH in the past three years ❑One month (this time is the first month) ❑Six Months ❑ Eleven Months ❑Two Months ❑Seven Months ❑Twelve Months ❑Three Months In Eight Months In More than 12 months ❑ Four Months ❑ Nine Months I Client doesn't know ❑ Five Months ❑Ten Months I Client prefers not to answer Data not collected DISABLING CONDITIONS AND BARRIERS Do you have a disabling condition? No ❑Client doesn't know ❑Client prefers not to answer Yes ❑Data not collected Do you have a physical disability? No El Client doesn't know ❑Client prefers not to answer Yes ❑ Data not collected If yes for Physical Disability, No In Client doesn't know ❑Client prefers not to answer 4 Revised 10/01/2023 FY 2024 OC HMIS: PROJECT INTAKE FORM — GENERAL & CoC/ESG Expected to be of long-continued and indefinite duration and Yes El Data not collected substantially impairs ability to live independently? Do you have a developmental disability? ❑No 0 Client doesn't know 0 Client prefers not to answer o Yes 0 Data not collected Do you have a chronic health condition? ❑ No 0 Client doesn't know 0 Client prefers not to answer r Yes ❑Data not collected If yes for Chronic Health Condition, ❑No 0 Client doesn't know Expected to be of long-continued and indefinite duration and 0 Client prefers not to answer substantially impairs ability to live independently? ❑Yes 0 Data not collected Have you been diagnosed with AIDS or have you tested positive for HIV? L No ❑Client doesn't know ❑Client prefers not to answer I]Yes ❑Data not collected Do you have a mental health problem? ❑No 0 Client doesn't know ❑Client prefers not to answer ❑Yes 0 Data not collected If yes for Mental Health Problem, ❑No 0 Client doesn't know Expected to be of long-continued and indefinite duration and ❑Client prefers not to answer substantially impairs ability to live independently? ❑Yes 0 Data not collected Do you have a substance abuse problem? ❑No 0 Client doesn't know ❑Alcohol Abuse 0 Client prefers not to answer ❑Drug Abuse 0 Data not collected n Both Alcohol and Drug If you have any Substance Abuse Problem, ❑No ❑Client doesn't know Expected to be of long-continued and indefinite duration and ❑Client prefers not to answer substantially impairs ability to live independently? ❑Yes ❑Data not collected Are you a survivor of domestic or intimate partner violence? u No 0 Client doesn't know ❑Client prefers not to answer o Yes 0 Data not collected If Yes for survivor of domestic or intimate partner violence When did this experience ❑Within the past three months ❑Client doesn't know occur? 0 Three to six months ago(excluding six months exactly) 0 Client prefers not to answer ❑From six to twelve months ago(excluding one year exactly) ❑Data not collected 0 More than a year ago El No 0 Client doesn't know Are you currently fleeing? ❑Yes 0 Client prefers not to answer ❑Data not collected 5 Revised 10/01/2023 FY 2024 OC HMIS: PROJECT INTAKE FORM — GENERAL & CoCIESG MONTHLY INCOME AND SOURCES ❑Client doesn't know Income from Any Source No ❑Client prefers not to Yes answer ❑ Data not collected IF "YES"TO INCOME FROM ANY SOURCE—INDICATE ALL SOURCES THAT APPLY Income Source(Check all that apply) Monthly Amount ❑ Earned Income ❑ Unemployment Insurance ❑Worker's Compensation ❑ Private Disability Insurance ❑VA Service-Connected Disability Compensation ❑Social Security Disability Income(SSDI) ❑Supplemental Security Income(SSI) ❑ Retirement Income from Social Security ❑VA Non-Service-Connected Disability Pension ❑ Pension or retirement income from a former job ❑Temporary Assistance for Needy Families(TANF) ❑General Assistance(GA) ❑Alimony or other spousal support LI Child Support ❑Other Cash Income(Specify: NON-CASH BENEFITS Receiving Non-Cash Benefits? No ❑Client doesn't know ❑Client prefers not to answer Yes ❑ Data not collected IF "YES"TO RECEIVING NON-CASH BENEFITS—INDICATE ALL SOURCES THAT APPLY ❑Supplemental Nutrition Assistance Program (SNAP) ❑TANF Transportation Services ❑Special Supplemental Nutrition Program for Women, ❑Other TANF funded services Infants,and Children (WIC) ❑Other Non-Cash Benefits ❑TANF Childcare Services (Specify Source): HEALTH INSURANCE ❑Client doesn't know Covered by Health Insurance? No ❑Client prefers not to Yes answer ❑ Data not collected IF "YES"TO COVERED BY HEALTH INSURANCE—INDICATE ALL SOURCES THAT APPLY ❑ MEDICAID ❑ Insurance Obtained through COBRA ❑ MEDICARE ❑ Private Pay Health Insurance ❑State Children's Health Insurance Program ❑State Health Insurance for Adults ❑Veteran's Health Administration (VHA) ❑ Indian Health Services Program ❑ Employer-provided Health Insurance III Other HealthInsurance (Specify Sourr ce): 6 Revised 10/01/2023 FY 2024 OC HMIS: PROJECT INTAKE FORM — GENERAL & CoC/ESG LAST PERMANENT ADDRESS Prior City The last city in which the client was permanently housed prior to entry into this project OC CUSTOM QUESTIONS What city were you in immediately prior to entry into this project? The city in which the client spent the night prior to entry into this project ❑Aliso Viejo ❑ Huntington Beach ❑ Newport Beach ❑Westminster ❑Anaheim ❑ Irvine ❑Orange ❑Yorba Linda ❑Brea ❑ La Habra ❑ Placentia ❑ Unincorporated Orange ❑Buena Park ❑ La Palma ❑ Rancho Santa Margarita County ❑Costa Mesa ❑ Laguna Beach ❑San Clemente ❑Outside Orange County, ❑Cypress ❑ Laguna Hills ❑ San Juan Capistrano but in California ❑ Dana Point ❑ Laguna Niguel ❑ Santa Ana ❑ Outside of California ❑ El Modena ❑ Laguna Woods ❑ Seal Beach ❑ Client doesn't know ❑Fountain Valley ❑ Lake Forest ❑Stanton ❑Client prefers not to answer ❑Fullerton ❑ Los Alamitos ❑Tustin ❑ Data not collected ❑Garden Grove ❑ Mission Viejo ❑Villa Park Phone Number(Optional) Email Address (Optional) What state were you born in? ❑AL-Alabama ❑GA-Georgia ❑ MA-Massachusetts ❑ NM-New Mexico ❑TN-Tennessee ❑AL-Alaska ❑ HI-Hawaii ❑ MI-Michigan ❑ NY-New York ❑TX-Texas ❑AZ-Arizona ❑ID- Idaho ❑ MN-Minnesota ❑ NC-North Carolina ❑ UT- Utah ❑AR-Arkansas ❑ IL- Illinois ❑ MS-Mississippi ❑ ND-North Dakota ❑VT-Vermont ❑CA-California ❑ IN-Indiana ❑ MO-Missouri ❑OH-Ohio ❑VA-Virginia ❑CO-Colorado ❑ IA- Iowa ❑ MT- Montana 0 OK-Oklahoma ❑WA-Washington El CT-Connecticut ❑ KS-Kansas ❑NE-Nebraska ❑OR-Oregon ❑WV-West Virginia ❑ DE- Delaware ❑ KY-Kentucky ❑NV-Nevada ❑ PA-Pennsylvania ❑WI-Wisconsin ❑ DC-District of ❑ LA-Louisiana ❑NH-New ❑ RI-Rhode Island ❑WY-Wyoming Columbia ❑ ME-Maine Hampshire ❑SC-South Carolina ❑Client doesn't know ❑ FL-Florida ❑ MD- Maryland ❑ NJ-New Jersey ❑SD-South Dakota ❑Client prefers not to answer ❑ Other If`Other'for State you were born, Which country were you born in? Employment Status ❑ Full-Time ❑ Unemployed ❑Client doesn't know ❑ Part-Time ❑ Disabled ❑Client prefers not to answer ❑Seasonal/Temporary ❑ Retired ❑ Data not collected Work CFCOC ENTRY QUESTIONS Is this client receiving services funded by the Children and Families Commission No Orange County? Yes 7 Revised 10/01/2023 FY 2024 OC HMIS: PROJECT INTAKE FORM — GENERAL & CoC/ESG CFCOC Bed Night Start Date / / The client's first bed night funded by CFCOC CFCOC Bed Night End Date / / The client's last bed night funded by CFCOC I certify that the information above is correct to the best of my knowledge. Client Signature Date Agency Staff Signature Date DO NOT ANSWER QUESTIONS BELOW—DATA ENTRY PERSONNEL ONLY(Optional): Date entered into HMIS: / / Question Answer Comments Was the hard copy intake form ❑No completely filled out correctly? ❑Yes Staff Name(verifying completion of Data Entry): 8 Revised 10/01/2023 Exhibit A - Appendix C Declaration of Homelessness Appendix C Declaration of Homelessness FAMILIES FnRWARD Families Forward Housing Program Housing Situation Certification Applicant Name: 0 Household without dependent children (complete one form for each adult in the household) 0 Household with dependent children (complete one form for household) Number of persons in the household: This is to certify that the above named individual or household is currently homeless or at-risk of homelessness based on the check mark, other indicated information, and signature indicating their current living situation. Check only one and complete only that section Living Situation: place not meant for human habitation (e.g., cars, parks, abandoned buildings, streets/sidewalks) O The person(s) named above is/are currently living in (or, if currently in hospital or other institution, was living in immediately prior to hospital/institution admission) 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 station, airport, or campground. Description of current living situation: Living Situation: Emergency Shelter O The person(s) named above is/are currently living in) a supervised publicly or privately operated shelter or, if currently in a motel where a charitable or government/state agency is paying for the stay. Emergency Shelter Program Name: Living Situation: Transitional Housing O The person(s) named above is/are currently living in a transitional housing program for persons who are homeless. The persons(s) named above is/are graduating from or timing out of the transitional housing program Transitional Housing Program Name: Living Situation: Permanent Housing Situation O The person(s) named above is/are currently living in a friends/family member's room, apartment or house on a temporary basis. O The person(s) named above is/are currently living in a rental by client, with RRH or equivalent subsidy. O The person(s) named above is/are currently living in a rental by client, with permanent housing support (other than RRH) for formerly homeless persons. O The person(s) named above is/are currently living in a hotel or motel paid for without emergency shelter voucher O The person(s) named above is/are currently living in a rental by client, with no ongoing housing subsidy Description of current living situation: , have provided Families Forward with 3,d party (Client's Name) verification of current housing situation (see attached document). OR , certify that the housing information provided (Case Manager Name) is accurate by visually inspecting the client'svehicle on (Date) Applicant Name(printed): Date: Applicant Name (signed): Date: Applicant Name(printed): Date: Applicant Name (signed): Date: Case Manager(printed): Date: Case Manager(signed): Date: • • Exhibit A - Appendix D HQS Inspection Checklist Inspection Checklist U.S.Department of Housing OMB Approval No.2577-0169 and Urban Development • (Exp.04/30/2026) Housing Choice Voucher Program Office of Public and Indian Housing OMB Burden Statement:The public reporting burden for this collection of information is estimated to average 0.50 hours per response,including the time for re viewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.As surances of confidentiality are not provided under this collection.Send comments regarding this burden estimate or any other aspect of this collection of informat ion,including suggestions to reduce this burden,to the Office of Public and Indian Housing,US.Department of Housing and Urbah Development,Washington, DC 20410.HUD may not conduct and sponsor,and a person is not required to respond to,a collection of information unless the collection displays a valid contr of number. Privacy Notice:The Department of Housing and Urban Development(HUD)is authorized to collect the information required on this form by 24 CFR§982.401. The information is used to determine if a unit meets the housing quality standards of the Section 8 rental assistance program.The Personally Identifiable Inform ation(PII)data collected on this form are not stored or retrieved within a system of record. Name of Family Tenant ID Number Date of Request(mm/dd/yyyy) Inspector Neighborhood/Census Tract Date of Inspection(mm/dd/yyyy) • Type of Inspection Date of Last Inspection(mm/dd/yyyy) PHA Initial I I Special I I Reinspection n A. General Information Inspected Unit Year Constructed(yyyy) Housing Type(check as appropriate) Full Address(including Street,City,County,State,Zip) 0 Single Family Detached 0 Duplex or Two Family • 0 Row House or Town House 0 Low Rise:3,'4 Stories, Including Garden Apartment Number of Children in Family Under 6 0 High Rise;5 or More Stories 0 Manufactured Home Owner __ 0 Congregate Name of Owner or Agent Authorized to Lease Unit Inspected Phone Number 0 Cooperative Independent Group Residence Address of Owner or Agent 0 Single Room Occupancy 0 Shared Housing 0 Other B. Summary Decision On Unit(To be completed after form has been filled out Pass Number of Bedrooms for Purposes Number of Sleeping Rooms Fail of the FMR or Payment Standard Inconclusive Inspection Checklist ken Yes No In- Final Approval No. 1.Living Room Pass Fail Conc. Comment Date(mm/dd/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(4/2023) *Room Codes:1=Bedroom or Any Other Room Used for Sleeping(regardless of type of room); 2=Dining Room or Dining Area; 3=Second Living Room,Family Room,Den,Playroom,TV Room;4=Entrance Halls,Corridors,Halls,Staircases;5=Additional Bathroom;6=Other Item 1. Living Room (Continued) Yes No In- Final Approval No. Pas Fall Conc. Comment Date(mm/dd/yyyy) 1'9 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. 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 (4/2023) Yes No n- Item N..4.Other Rooms Used For Living and Halls Pass Fail CI nc.,. I Final Approval Comment I Date mm/ddh _ 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 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 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 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 Wall Condition 4.8 Floor Condition 4.9 Lead-Based Paint El '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? ' I I Previous editions are obsolete Page 3 of 8 form HUD-52580(4/2023) Item 4.Other Rooms Used For Living and Halls Yes No In- Final Approval No. Pass Fail Conc. Comment Date(mmldd/yyyy) 4.1 Room Code* (Circle One) (Circle One) and 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 I 4.6 Ceiling Condition I 4.7 Wall Condition I I I 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 I I I 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 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 5.All Secondary Rooms (Rooms not used for living) 5.1 None 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-52580 (4/2023) Item 6.Building Exterior Yes No in- Final Approval No. Pass Fail Conc. Comment i (Date(mMddlyyyy) 6.1 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(4/2023) 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. u.Questions to ask the Tenant(Optional) 1. Living Room 4.Bath High quality floors or wall coverings Special feature shower head Working fireplace or stove Balcony, — Built-in heat lamp patio, deck, porch Special windows Large mirrors or doors — Glass door on shower/tub I Exceptional size relative to needs of family —I Separate dressing room Other:(Specify) —1 Double sink or special lavatory Exceptional size relative to needs of family —I 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 5.Overall Characteristics Double sink Storm windows and doors — High quality cabinets Other forms 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 High quality floors or wall coverings 1—I Working fireplace or stove Balcony, 0 patio, deck, porch Special windows 6.Accessibility for Individuals with Disabilities Eor doors Exceptional size relative to needs of family Unit is accessible to a particular disability. I I Yes No Other.(Specify) Disability LI Previous editions are obsolete Page 6 of 8 form HUD-52580(4/2023) 1. Does the owner make repairs when asked?Yes _ No I I 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) 5. Who owns the range and refrigerator? (insert 0= Owner or T=Tenant) Range Refrigerator Microwave 6. Is there anything else you want to tell us?(specify)Yes No ri • Previous editions are obsolete Page 7 of 8 form HUD-52580(4/2023) E.Inspection Summary/Comments(Optional) Provide a summary description of each item which resulted in a rating of"FaiP'or"Pass with Comments." Tenant ID Number Inspector Date of Inspection(mm/dd/yyyy)Address of Inspected Unit Type of Inspection Initial Special Reinspection Item Number Reason for"Fail"or"Pass with Comments"Rating • Continued on additional page Yes No n Previous editions are obsolete Page 8 of 8 form HUD-52580(4/2023) Exhibit A - Appendix E Rent Reasonableness Checklist RENT REASONABLENESS CHECKLIST AND CERTIFICATION 24 CFR 574.320 (a)(3) Rent reasonableness. The rent charged for a unit must be reasonable in relation to rents currently being charged for comparable units in the private unassisted market and must not be in excess of rents currently being charged by the owner for comparable unassisted units. Proposed Unit Unit#1 Unit#2 Unit#3 Address Number of Bedrooms Square Feet Type of Unit/Construction Housing Condition Location/Accessibility Amenities Unit: Site: Neighborhood: Age in Years Utilities (type) Unit Rent Utility Allowance Gross Rent Handicap Accessible? Most Recently Charged Rent Reason for For Proposed Unit Change *Other local resources may be used to obtain information, e.g.: market surveys, classified ads. I certify that I am not a HUD certified inspector and I have evaluated the property located at the above address to the best of my ability and find the following: CERTIFICATION: A. Compliance with Payment Standard Proposed Contract Rent + Utility Allowance = Proposed Gross Rent Approved rent does 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: SAMPLE FORM UPDATED JULY 2006 I OF 1 • Exhibit A - Appendix F Lease Contract i . • . HOME RENTAL ASSISTANCE CONTRACT LANDLORD NAME &ADDRESS UNIT NO. &ADDRESS TENANT NAME(S) Telephone No. This HOME Rental Assistance Contract ("Contract") is entered into between "Families Forward" (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 2 The Contract automatically terminates on the last day of the term of the Lease. 2. SECURITY DEPOSIT A. The(program administrator)will pay a security deposit to the Landlord in the amount of $ . The Landlord will hold this security deposit during the period the Tenant occupies the dwelling unit under the Lease. The Landlord shall comply with state and local laws regarding interest payments on security deposits. B. After the Tenant has moved from the dwelling unit, the Landlord may, subject to state and local law, use the security deposit, including any interest on the deposit, as reimbursement for rent or any other amounts payable by the Tenant under the Lease. The Landlord will give the Tenant a written list of all items charged against the security deposit and the amount of each item. After deducting the amount used as reimbursement to the Landlord, the Landlord shall promptly refund the full amount of the balance to the[Tenant/program administrator]. C. The Landlord shall immediately notify the(program administrator)when the Tenant has moved from the Contract unit. 3. RENT AND AMOUNTS PAYABLE BY TENANT AND(program administrator) A. Initial Rent. The initial total monthly rent payable to the Landlord for the first twelve months of this Contract is $ . Rent reasonableness will be determined and the lease will be disapproved if not reasonable in accordance with 24 CFR 92.209(f)(k). B. Rent Adjustments. With no less than 603 days' notice to the Tenant and the (program administrator), the owner may propose a reasonable adjustment to be effective no earlier than the 13th month of this Contract. The proposed rent may be rejected by either the Tenant or the (program administrator). The Tenant may reject the proposed rent by providing the Landlord 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 Rent. 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 ' Insert the first day of program enrollment or Lease start date(if after program enrollment). 2 Projected program Exit date. 3 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. HOME Rental Assistance Contract(Page Two) D. Program Administrator Share of the Rent. Initially, and until such time as both the Landlord and Tenant are notified by the (program administrator), the (program administrator's) share of the rent shall be$ . _. If client maintains program eligibility at their six-month re- certification. Neither the (program administrator) nor HUD assumes any obligation for the Tenant's rent, or for payment of any claim by the Owner against the Tenant. The (program administrator's) obligation is limited to making rental payments on behalf of the Tenant in accordance with this Contract. E. Payment Conditions. The right of the owner to receive payments under this Contract shall be subject to compliance with all of the provisions of the Contract. The Landlord shall be paid under this Contract on or about the first day of the month for which the payment is due. The Landlord agrees that the endorsement on the check shall be conclusive evidence that the Landlord received the full amount due for the month, and shall be a certification that: 1. the Contract unit is in decent, safe and sanitary condition, and that the Landlord is providing the services, maintenance and utilities agreed to in the Lease. 2. the Contract unit is leased to and occupied by the Tenant named above in this Contract. 3. the Landlord has not received and will not receive any payments as rent for the Contract unit other than those identified in this Contract. 4. to the best of the Landlord's knowledge, the unit is used solely as the Tenant's principal place of residence. F. Overpayments. If the(program administrator) determines that the Landlord is not entitled to any payments received, in addition to other remedies, the (program administrator) may deduct the amount of the overpayment from any amounts due the Landlord, including the amounts due under any other Rental Assistance Coupon Contract. 4. HOUSING QUALITY STANDARDS AND LANDLORD-PROVIDED SERVICES A. The Landlord agrees to maintain and operate the Contract unit and related facilities to provide decent, safe and sanitary housing in accordance with 24 CFR Section 882.109, including all of the services, maintenance and utilities agreed to in the Lease. B. The (program administrator) shall have the right to inspect the Contract unit and related facilities at least annually per 24 CFR 92.209(i), and at such other times as may be necessary to assure that the unit is in decent, safe, and sanitary condition, and that required maintenance, services and utilities are provided. C. If 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. 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 breach or to compel compliance by the Landlord. B. Cooperation in Quality Opportunity Compliance Reviews. The Landlord shall comply with the (program administrator) and with HUD in conducting compliance reviews and complaint investigations pursuant to all applicable civil rights statutes, Executive Orders and all related rules and regulations. 7. (Program administrator)AND HUD ACCESS TO LANDLORD RECORDS A. The Landlord shall provide any information pertinent to this Contract which the(program administrator) or HUD may reasonably require. B. The Landlord shall permit the (program administrator) of HUD, or any of their authorized representatives, to have access to the premises and,for the purposes of audit and examination,to have access to any books, documents, papers, and records of the Landlord to the extent necessary to determine compliance with this Contract. 8. RIGHTS OF(Program administrator)IF LANDLORD BREACHES THE CONTRACT A. Any of the following shall constitute a breach of the Contract: (1) If the Landlord has violated any obligation under this Contract; or (2) If the Landlord has demonstrated any intention to violate any obligation under this Contract; or (3) If the Landlord has committed any fraud or made any false statement in connection with the Contract, or has committed fraud or made any false statement in connection with any Federal housing assistance program. B. The PHA's right and remedies under the Contract include recovery of overpayments, termination or reduction of payments, and termination of the Contract. If the(program administrator)determines that a breach has occurred, the program administrator may exercise any of its rights or remedies under the Contract. The(program administrator) shall notify the Landlord in writing 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. 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 Contract does not create or affect any relationship between the (program administrator) and any lender to the Landlord, or any suppliers, employees, contractors or subcontractors used by the Landlord in connection with this Contract. C. Nothing in this Contract shall be construed as creating any right of the Tenant or a third party (other than HUD)to enforce any provision of this Contract or to asses any claim against HUD, the (program administrator) or the Landlord under this Contract. 10. CONFLICT OF INTEREST PROVISIONS A. No employee of the (program administrator)who formulates policy or influences decisions with respect to the Rental Assistance Program, and no public official or member of a governing body or state of local legislator who exercise his functions or responsibilities with respect to the program shall have any direct or indirect interest during this person's tenure, or for one year thereafter, in this contract or in any proceeds or benefits arising from the Contract or to any benefits which may arise from it. 11. TRANSFER OF THE CONTRACT The Landlord shall not transfer in any form this Contract without the prior written consent of the (program administrator). The(program administrator) shall give its consent to a transfer if the transferee agrees in writing (in a form acceptable to the(program administrator))to comply with all terms and conditions of this Contract. 12. ENTIRE AGREEMENT: INTERPRETATION A. This Contract contains the entire agreement between the Landlord and the program administrator. No changes in this Contract shall be made except in writing signed by both the Landlord and the(program administrator). B. The Contract shall be interpreted and implemented in accordance with HUD requirements. HOME Rental Assistance Contract(Page Five) 13. WARRANTY OF LEGAL CAPACITY AND CONDITION OF UNIT A. The Landlord warrants the unit is in decent, safe, and sanitary condition as defined in 24 CFR Section 882.109, and that the Landlord has the legal right to lease the dwelling unit covered by this Contract during the Contract term. B. The party, if any, executing this Contract on behalf of the Landlord hereby warrants that authorization has been given by the Landlord to execute it on behalf of the Landlord. Landlord Name(Type or Print): (Program administrator)Representative(Type or Print): (Signature/Date) (Signature/Date) WARNING: 18 U.S.C. 1001 provides, among other things,that whoever knowingly and willingly makes or uses a document or writing containing any false,fictitious, or fraudulent statements or entries, in any matter within the jurisdiction of any department or agency of the United States, shall be fined not more than $10,000, or imprisoned for not more than five years, or both. LANDLORD'S CHECK TO BE MAILED TO: EIN NO. (last four digits) NAME(S) ADDRESS SIGNATURE OF OWNER DATE SIGNATURE OF OWNER DATE Exhibit A - Appendix G Lease Addendum LEASE ADDENDUM TENANT LANDLORD UNIT NO. &ADDRESS This lease addendum adds the following paragraphs to the Lease between the Tenant and Landlord referred to above. A. Purpose of the Addendum. The lease for the above-referenced unit is being amended to include the provisions of this addendum because the Tenant has been approved to receive rental assistance under the [program administrator's] HOME Rental Assistance Program. Under the Rental Assistance Program, the [program administrator] will make monthly payments to the Landlord on behalf of the Tenant. The Lease has been signed by the parties on the condition that the [program administrator] and Landlord will promptly execute a HOME Rental Assistance Contract. This Lease shall not become effective unless the Contract has been executed by both the Landlord and the [program administrator], effective the first day of the term of the Lease. B. Conflict with Other Provisions of the Lease. In case of any conflict between the provisions of this Addendum and other sections of the Lease, the provisions of this Addendum shall prevail. C. Terms of the Lease. The term shall begin on and shall continue until: (1) the Lease is terminated by the Landlord in accordance with applicable state and local Tenant/Landlord laws; (2) the Lease is terminated by the Tenant in accordance with the Lease or by mutual agreement during the term of the Lease; or(3) termination of the HOME Rental Assistance Program Contract by the [program administrator]. D. Rental Assistance Payment. Each month the [program administrator]will make a rental assistance payment to the Landlord on behalf of the Tenant. This payment shall be credited by the Landlord toward the monthly rent payable by the Tenant. The balance of the monthly rent shall be paid by the Tenant. E. Security Deposit (1) The (Tenant/[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. (2) After the Tenant has moved from the dwelling unit, the Landlord may, subject to state and local laws, use the security deposit, including any interest on the deposit, as reimbursement for rent or any other amounts payable by the tenant under the Lease. The Landlord will give the Tenant a written list of all items charged against the security deposit and the amount of each item. After deducting the amount used as reimbursement to the Landlord, the Landlord shall promptly refund the full amount of the balance to the (Tenant/[program administrator]). F. Utilities and Appliances. The utilities and appliances listed in Column 1 are provided by the Landlord and included in the rent. The utilities and appliances listed in Column 2 below are not included in the rent and are paid separately by the Tenant. UTILITY/APPLIANCE Included in Rent Tenant Paid Garbage Collection Water/Sewer Heating Fuel (specify) Lights, electric Cooking Fuel (specify) Other(specify) Refrigerator Stove/Range G. Household Members. Household members authorized to live in this unit are listed below. The Tenant may not permit other persons to join the Household without notifying the [program administrator] and obtaining the Landlord's permission. Household members: H. Housing Quality Standards. The Landlord shall maintain the dwelling unit, common areas, equipment, facilities and appliances in decent, safe, and sanitary condition (as determined by Section 8 Housing Quality Standards). 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. J. Prohibited Lease Provision. Any provision of the Lease which falls within the classifications below shall not apply and not be enforced by the Landlord. (1) Confession of Judgment. Consent by the Tenant to be sued, to admit guilt, or to a judgment in favor of the landlord in a lawsuit brought in connection with the Lease. (2) Treatment of Property. Agreement by the Tenant that the Landlord may take or hold the Tenant's property, or may sell such property without notice to the Tenant and a court decision on the rights of the parties. (3) Excusing the Landlord from Responsibility. Agreement by the Tenant not to hold the Landlord or Landlord's agent legally responsible for any action or failure to act, whether intentional or negligent. (4) Waiver of Legal Notice. Agreement by the Tenant that the Landlord may institute a lawsuit without notice to the Tenant. (5) Waiver of Court Proceedings for Eviction. Agreement by the Tenant that the Landlord may evict the Tenant Family (i) without instituting a civil court proceedings in which the Family has the opportunity to present a defense, or(ii) before a decision by the court on the rights of the parties. (6) Waiver of Jury Trial. Authorization to the Landlord to waive the Tenant's right to a trial by jury. (7) Waiver of Right to Appeal Court Decision. Authorization to the Landlord to waive the Tenant's right to appeal a court decision or waive the Tenant's right to sue to prevent a judgment from being put into effect. (8) Tenant Chargeable with Cost of Legal Actions Regardless of Outcome of the Lawsuit. Agreement by the Tenant to pay lawyer's fees or other legal costs whenever the Landlord decides to sue, whether or not the Tenant wins. K. Nondiscrimination. The Landlord shall not discriminate against the Tenant in the provision of services, or in any other manner, on the grounds of age, race, color, creed, religion, sex, handicap, national origin, or familial status. TENANT SIGNATURES LANDLORD SIGNATURES By: 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) Exhibit A - Appendix H Participant Agreement Families Forward Housing Program Contract Families Forward provides a Housing Program for families who are without housing and who do not have the financial resources to provide housing for themselves. No distinction is made regarding admittance based on race, religion, age, sex or ethnic origin. 1. The rent is required to be paid on the deadline provided in the lease agreement. 2. Family will provide a copy of rental ledger during each family meeting with Case Manager. 3. Each tenant will receive support in maintaining a monthly budget. Monthly meetings will be scheduled to verify income, expenses and collect pay stubs in order to complete the monthly budget. 4. Family is to maintain communication with the Case Manager with regards to progress, problems, change in employment status or other concerns. 5. Families Forward Staff are mandated reporters, which are professionals, required by law to report any reasonable suspicion of abuse or neglect inflicted on children and/or dependent adults. Any investigations will be conducted by law enforcement, county agency and/or the child welfare department to determine if abuse or neglect has occurred. 6. Family is responsible for keeping the property clean and well maintained at all times. 7. Tenant will complete a Tenant Screening. Family will have regular check-ins with Case Manager until housing is identified.These meetings will include discussions on housing options in Orange County, current market rates by area, and barriers and strategies to circumvent these issues. 8. Family will allow for home inspections to be completed on the property by the Case Manager. These home inspections will be done once a month. 9. Families Forward reserves the right to terminate housing assistance in the event the tenant violates regulations outlined in the lease and/or rental agreement. 10. It is a violation of the agreement to allow anyone not stated on the lease to assume residence in the tenant's property. 11. Families Forward Staff will assist the tenant as appropriate to achieve self-sufficiency. Applicant Date Case Manager Date Applicant Date Exhibit A - Appendix I Utility Allowance C n dCCommunity Resources 2024 Utility Allowance Schedule The following utility allowances will be used by the Orange County Housing Authority for administration of the Housing Choice Voucher Program effective October 1, 2023. Bedroom 0 1 2 3 -. 5 '�" ,*`, re-:� '"?"' ' -4 i.Ax" i,R YE T s a tt'-l. : €"" - a°^sa . 'L m*"# rV Cooking 4 4 7 9 12 13 Heating 16 18 21 22 25 27 Water Heatin• 9 10 14 20 26 31 Natural Gas Base Cherie 4 Basic 30 35 49 65 82 100 Cooking 10 11 17 21 27 32 Heating 19 22 25 28 30 35 Water Heatin• 25 30 ,�38 _ 46 55 63 ? ,-.:1• 1..,- � %c.Y�z: ..s>;. c..,.-11 .v.,.+ 4 sue t o3..*. •. .s; Air Conditionin• 11 13 19 23 30 41 Water 45 49 71 104 138 171 Sewer 7 7 7 7 7 7 Trash 23 Refrigerator 12 Stove 11 Note: Effective October 1, 2023, OCHA will allow Affordable Housing developments with OCHA project-based vouchers to request a waiver to establish a site-specific Utility Allowance schedule calculated using the California Utility Allowance Calculator. For more information on the waiver process, please contact our project-based voucher team at(714)480-2765. OC HOUSING AUTHORITY 1501 E.ST.ANOREW PLACE,FIRSTFLOOR,SANTAANA,CA92705 I PH0NE(714)480-2 7 00FAX(714)480-2945 • Exhibit A - Appendix J Case Management and Self-Sufficiency Program Policies and Procedures Table of Contents Overview 3 Equal Opportunity and Nondiscrimination 3 Confidentiality 4 Program Eligibility 4 Eligibility Definitions 4 Literally Homeless: 4 At Risk of Homelessness: 5 McKinney-Vento Definition 6 Family Solutions Collaborative 6 Introduction 6 Families Forward and The Family Solutions Collaborative 6 Access Point 7 Community Queue 7 Programs 8 Prevention & Diversion 8 History 8 Services Provided 8 Service Request Forms 9 Prevention Process Overview 9 Diversion Process Overview 12 Literally Homeless Overview 13 Rapid Rehousing 15 History 15 Services Provided 16 Intake Process 17 Family Meetings 18 Government Grants 19 ESG Grants 19 ESG Prioritization and Intake 20 ESG Eligibility 20 ESG Transportation Policy 21 Prevention 21 Irvine ESG 21 Families Forward General Prevention and Diversion Funds 22 SAUSD 22 Rapid Rehousing 22 County of Orange RRH+ 22 Housing Choice Vouchers (HCV) 22 HUD 22 Strong Families Strong Children (SFSC) 23 Tenant-Based Rental Assistance (TBRA) 23 Private Funding and Other Funding 25 1IPage Last Revised: May 31, 2024 Make a Difference 25 Nancy Chase 25 Financial Assistance 25 ESG Assistance 25 P&D Assistance 26 Data and Compliance 26 Data Systems 26 CiviCore (NeonOne) 26 HMIS (Clarity) 26 Data Deadlines 28 New family data 28 Services 28 Exiting Families Upon Completion of Program 28 Case Notes 28 Family Navigation 28 Caseloads Management 28 Forms 29 Client Files 29 Rapid Rehousing 29 Forms 29 Client Files 29 Maintaining Record Keeping 29 Best Practices 30 Caseloads 30 Exhibits 31 Prevention Flow Chart 31 Literally Homeless Flow Chart 32 SAUSD Prevention Flowchart 33 SAUSD Literally Homeless Flowchart 34 Prevention Assessment Tool 35 File Index— Prevention & Diversion 36 File Index— Housing Program (HP) 37 2 ' Page Last Revised: May 31, 2024 Program Manual Overview • Families Forward's mission is to prevent and end family homelessness by providing access to housing and resources that create lasting stability. • Families Forward does not operate a shelter program, nor do we provide emergency housing. We help families with identifying and accessing permanent housing. The housing search is based on the individual family's needs. Families Forward's Housing Program includes housing navigation, case management services, career and counseling services, food pantry and seasonal programs, and if allowable, rental subsidies. Our goal is to help families achieve stability and move toward self-sufficiency. Equal Opportunity and Nondiscrimination • It is the policy of Families Forward to comply fully with all Federal, State, and local non- discrimination laws and regulations governing Fair Housing and Equal Opportunity in housing. • Families Forward will not deny any individual an equal opportunity on the basis of race, color, gender identity, religion, national or ethnic origin, age, familial status, or a mental or physical disability. o Individuals are placed, served, and accommodated in accordance with their gender identity and are not subjected to intrusive questioning or asked to provide anatomical information or documentary, physical, or medical evidence of the individual's gender identity o Households with children under 18 are not denied admission based on the age of any child under 18. • It is the policy of Families Forward to provide reasonable accommodations for limitations or modifications needed by a disabled person due to a mental or physical disability of the individual. • Families Forward ensures effective communication with interested persons with disabilities concerning the location of assistance, services, and facilities that are accessible to persons with disabilities by providing appropriate auxiliary aides and services when requested or if staff of volunteers perceive they are needed. Aides include virtual meetings, multiple forms of communication, Boost Lingo, elevators, ADA compliant buildings, meeting at client's location if not able to meet in our office. We are committed to meeting all client needs within reasonable capacity. • Families Forward prioritizes hiring staff who are fluent in Spanish and other languages. In addition, through leveraged funds, Families Forward uses Boost Lingo to ensure meaningful access to programs and activities for limited English proficiency persons. • These policies are posted on our website and in all public areas, including our front desk and all client meeting rooms. 3IPage Last Revised: May 31, 2024 Confidentiality • Families Forward (FF) is an HMIS participating agency within 211 OC. • All HMIS Users, FF staff, and volunteers are required to ensure that personal identifying information (PII) is never sent across an unencrypted network, saved in an unprotected folder on a computer, or, in the case of hard copies of PII, stored anywhere other than a locked file cabinet or office. • PII CANNOT be sent over unencrypted email either between a participating agency and 211 OC or between staff at a participating agency. The only permissible way to discuss an individual client over unencrypted email is using the client's ID number. • For Emergency Solutions Grants (ESG) participants: All records containing PII of any individual or family who applies for and/or receives ESG assistance are kept secure and confidential; the address or location of any domestic violence, dating violence, sexual assault, or stalking shelter project assisted under ESG will not be made public, except with written authorization of the person responsible for the operation of the shelter; and the address or location of any program participant housing will not be made public. Program Eligibility Family Navigators represent the starting point for a family seeking services within the Family Coordinated Entry System (FCES). This includes paths for families who are literally homeless and those who are at risk of homelessness. The following are general requirements for FCES. • Family must live in or have strong verifiable ties to Orange County o A verifiable tie is documentation that is concrete that proves the client has a tie to any of the cities we have funding for. (Examples include current living situations, employment, or childcare/school enrollments.) • A household that has at least one minor age child in the household • Family must agree to provide necessary documentation if matched to a housing intervention like rapid re-housing or homeless prevention • Agree to work with and maintain regular communication with program staff • All program staff should reference eligibility requirements by funding type, as laid out in the grants section in this manual. Eligibility Definitions Literally Homeless: • A family who lacks a fixed, regular, and adequate nighttime residence, which includes those in a primary nighttime residence of: a. Place not designed for or ordinarily used as a regular sleeping accommodation (including a car, park, abandoned building, bus/train station, airport, or camping ground); b. 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); Wage Last Revised: May 31, 2024 c. Or an individual is considered homeless if she or he is being discharged from an institution where she or he has been a resident for 90 days or less and the person resided in a shelter (not transitional housing) or place not meant for human habitation immediately prior to entering that institution evidenced by: a. discharge paperwork or written or oral referral from a social worker, case manager, or other appropriate official of the institution, stating the beginning and end dates of the time residing in the institution, or b. a written record of the intake worker's due diligence in attempting to obtain the information above and a written certification by the individual seeking assistance that stated he or she is exiting (or has just exited) the institution where he or she resided for 90 days or less NOTE: Intake workers must document the content of oral statements. Where the intake worker is unable to contact an appropriate official, the intake worker must document his/her due diligence in attempting to obtain a statement from the institution. 24 CFR 576.2 "Homeless" At Risk of Homelessness: • A family currently at-risk of homelessness must meet the following criteria: o Have an annual income below 30 percent or the allowable threshold per grant. Annual income is typically expressed as a percentage of median family income for the area as determined by HUD; AND o Family does not have sufficient resources or support networks (such as family, friends, or religious networks) immediately available to prevent them from homelessness; AND o Meets at least one of the following conditions; a. Has moved for economic reasons two or more times during the past 60 days b. Is living in the home of another because of economic hardship; c. Has been notified in writing that their current housing or living situation will be terminated within 21 days; d. Lives in a hotel or motel, which is not subsidized by government or nonprofit resources; e. Lives in an overcrowded unit (more than 1.5 persons per room); f. Is exiting a publicly funded institution, such as a health-care facility, a mental health facility, foster care or other youth facility, or correction program or institution; OR g. Otherwise lives in housing that has characteristics associated with instability and an increased risk of homelessness, as identified in the recipient's approved consolidated plan. • A family may also qualify if they do not meet all of these criteria but have a child or children living in the house who qualifies as homeless under the Runaway and Homeless Youth Act or the Head Start Act or the Violence Against Women Act of 1994 or the Public Health Service Act or the Food and Nutrition Act of 2008 or the Child Nutrition Act of 1966 or the McKinney-Vento Homeless Assistance Act. 5 ' Page Last Revised: May 31, 2024 24 CFR 576.2 "At risk of homelessness" McKinney-Vento Definition • The term "homeless children and youths"- O (A) means individuals who lack a fixed, regular, and adequate nighttime residence (within the meaning of section 11302(a)(1) of this title); and o (B) includes— a. children and youths who are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; or are abandoned in hospitals; b. children and youths who have 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 (within the meaning of section 11302(a)(2)(C)1 of this title); c. children and youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and d. migratory children (as such term is defined in section 6399 of title 20) who qualify as homeless for the purposes of this part because the children are living in circumstances described in clauses (a) through (c). Family Solutions Collaborative Introduction • Families Forward is part of the Family Solutions Collaborative. The Family Solutions Collaborative or FSC and its members came together as a group of geographically diverse homeless service providers to analyze the efficacy of current resources for homeless families and inform systemic change that will end homelessness for children and families in Orange County. • The vision of the FSC is to have a family response system that will work to align resources for families in a streamlined process. The goal is to create consistency and efficiency to support a family accessing the system. Families will be linked quickly to appropriate services with a goal of ending their housing crisis within 30 days or less. Families Forward and The Family Solutions Collaborative • Families Forward is a South and Central Orange County Access Point. As an Access Point we work very closely with the Family Solutions Collaborative and the South and Central Orange County Family Service Navigators. The Family Service Navigator is the point of contact for the Coordinated Entry System and any concerns. • The Family Navigators meet with the South and Central Family Service Navigators on a bi-weekly basis to discuss their caseloads and any challenges they may be experiencing with clients. 6IPage Last Revised: May 31, 2024 Access Point • Access Points are defined as entry points to the Coordinated Entry System (CES) that offer access to services, including Diversion strategies as initial screening and prioritization for the CES. These may include navigation centers, access sites, mobile outreach teams and/or a virtual front door via the 2-1-1 Orange County telephonic resources, 211 OC/FSC website. • All Access Points a. Must have a physical location (navigation center), call center, or outreach team; b. Must have specific hours of operation; c. Must participate in HMIS; d. Must perform diversion; e. Must complete Client Profile Forms; f. Must perform housing navigation activities; g. Must be non-discriminatory; h. Must have Family Service Navigator(s) who spend time with families in crisis and with special and high acuity populations lacking housing, build relationships with them, identify and address their needs, and assist with linkage to direct services with a Progressive Engagement approach; i. Must provide navigation services to address the families' housing needs by completing Coordinated Entry System assessments. Ongoing engagement occurs when families are not accessing housing services. Follow-up will occur while a family is waiting for and is transitioning into a housing opportunity; j. Must have representation at Housing Placement Match Meeting and Case Conferencing. A designated representative from the Access Point must attend the ongoing Housing Placement Match Meetings and Case Conferencing meetings. • Review Access Point Manual from the Family Solutions Collaborative on more details about what is required from an Access Point and your role as a Family Navigator for an Access Point. Community Queue • The Community Queue is an interest list for families who are seeking a connection to an appropriate housing program, to further assist in their goal of finding a permanent housing solution. • The Family Navigator should complete a Housing Assessment Plan. The plan typically will include steps that the family needs to take to find employment to support housing and/or how to search for housing within the family's means. This plan should be uploaded into HMIS. • Review Access Point Manual from the Family Solutions Collaborative on more details about what is required from an Access Point and your role as a Family Navigator for an Access Point. 7IPage Last Revised: May 31, 2024 Programs Prevention & Diversion History • Prevention and Diversion is a program that started with limited funding and volunteers. Now, our Prevention and Diversion program has a team of Family Navigators and Prevention Specialist Volunteers that work with our families. At the start of the COVID-19 pandemic, the Prevention Specialist Volunteers went from volunteering in the office to now having the ability to volunteer from home. • As part of the Family Solutions Collaborative, Families Forward originally served as an Access Point for the South Service Planning Area (SPA). In 2021, Families Forward opened an office in the city of Santa Ana and now also serves as an Access Point for the Central SPA. • Family Navigators and Prevention Specialist Volunteers run the Prevention Program. The Prevention Program assists families who are at risk of homelessness and who are living in Central and South Orange County. The Prevention Specialist Volunteers and Family Navigators work with clients over the phone to determine if the family would be eligible for potential financial assistance. Clients who are eligible for financial assistance are referred to the Family Navigators for final review and document collection. Please note: each funding source may have different requirements. Services Provided Family navigation includes the following types of services for families who are experiencing homelessness or at risk of homelessness: Resources navigation • To stay up to date on referrals, collaboration with the Community Resource Coordinator on finding resources and potential referrals for families. In addition, Family Navigators can use the current resources list on SharePoint to send via email to clients. Financial Assistance • Rental assistance eligibility review • Security deposit assistance • Eviction prevention Light case management • After eligibility is determined and the family is enrolled into a program, case management conversations are required while providing rental assistance. Family Navigators will schedule a family meeting with all adults present.This will include completing and reviewing a budget, discussing resources, and creating goals towards sustainability. Additionally, a Career referral can be made if families are needing short career services to assist with their employment. Family Navigators will continue to check in with families at family meetings to also provide any additional resources that could best assist the family. If a family is referred to career, the Family Navigator will check in with the assigned Career Coach throughout client's case for open communication. Wage Last Revised: May 31, 2024 Referrals • Referrals to shelter opportunities, housing program opportunities, or other partnering agencies/programs Coordinated entry system • Assist families navigate through CES (CES) navigation • Assist with connections to emergency shelter through the bed reservation system The Orange County Homeless System can be overwhelming to families with the overflow of information. Additionally, the system is set up in a way to efficiently assist families by one service provider. With Family Navigation and Orange County's Coordinated Entry System, Family Navigators can guide and direct families to the appropriate program. Service Request Forms Family Service Request Forms • Family Service Request Forms are used to connect families to services within the Family Coordinated Entry System. Families can call Families Forward and speak to a Front Desk Volunteer who will collect their basic information to complete a Family Solutions Collaborative Service Request Form online. The request for services will go to the family's nearest Access Point. If Families Forward is the nearest Access Point, the Service Request Form will be routed automatically to the Families Forward Family Navigator via email. • The client may also complete a Service Request Form online by themselves through FSC's website. • If a physical Service Request Form is needed, staff or walk in clients can complete the PDF. Note: This physical Service Request Form is not often used. • Once Families Forward receives the Service Request Form, the intake Family Navigator will call the family to identify if family meets the criteria for any of Families Forward's Housing Programs. Programs include Prevention & Diversion and Rapid Re-Housing. Timeline of Service Request Forms • Once a Service Request Form is received and routed to an appropriate access point, based on city, the Family Navigation team will add household into Notion and CiviCore if not already working with another agency. o Intake Family Navigator will make the first attempt to contact the family within 3 business days o Intake Family Navigator will notate attempt in CiviCore o Upon connection with family, Intake Family Navigator will make referral to the appropriate Family Navigator • Families will be routed to appropriate Family Navigator based on current living situation, literally homeless or at-risk of homelessness o Family Navigator will connect with family and begin working on various interventions based on the family's needs Prevention Process Overview • Families Forward being both an Access Point in Central and South, assist families who have current ties to Central and South Orange County. 91Page Last Revised: May 31, 2024 • If a client indicates on the Service Request Form they are sleeping on someone's couch or floor (couch surfing), paying motel out of pocket or is currently renting a unit but cannot pay rent, and meets the above criteria for at-risk for homelessness, this categorizes the family as a prevention client. • Upon the first contact with families, the Family Navigator will ask questions about their current situation to support in determining if rental assistance or resources need to be provided to prevent families becoming homeless. • The Family Navigator will provide the client with resources that they may need in order to improve their situation (career resources, resources for rental assistance, car repairs, etc.). After the phone conversation the Family Navigator will send an email to the client recapping their discussion and the resources to help them. • All Family Navigator communication attempts will all be documented into CiviCore as a service and case note. • If the Family Navigator deems the family eligible for financial assistance, the Family Navigator will case conference with Senior Family Navigator or Service Navigation Manager who will determine eligibility for the grant the family could potentially utilize. Once deemed eligible the Family Navigator will work towards obtaining the required documentation for financial review. • Documents must be collected within 5 business days of determining eligibility for financial assistance. • Once all documents are collected and packet is completed; the Family Navigator will submit to the Data Entry Clerk and Senior Family Navigator/Service Navigation Manager for review. The Data Entry Clerk and Senior Family Navigator/Service Navigation Manager will review all documents and ask for clarification or additional documents if needed. • Depending on the funding source there is a required case management component. During the case management sessions, the Family Navigator will work with the family on budgeting and goals: o PROGRAM SERVICES— ■ Review and complete a new budget • Review and complete a new goal sheet • Discuss how they are doing and if they need any additional resources to assist them ■ Discuss employment and if needed, refer the client to the Career Coach See Prevention Flowchart in Exhibits FCES Prevention Process 1. Enroll all family members in FCES. 2. Complete a Current Living Situation Assessment for all adults in the household. 101Page Last Revised: May 31, 2024 PROGRAM:FAMILY COORDINATED ENTRY SYSTEM Entailment History Provide Services Assessments •.t rle. X Mat Assessments LINK rEnt.S.:MU MS Current Living sNoation 3. Complete the Prevention Assessment Tool for the Head of Household only. a. If a client scores 12 or above they are eligible. 4. Enter a Prevention Assistance Service for the HoH a. No notes need to be added in the service notes section. PROGRAM FAMILY COORDINATED ENTRY SYSTEM Enrollment Hlstary Provide services Asor:sments Pastes Fret t. Services Ded Reservation Wad List Case Management v Case Managenved Mama,Coord.natcd entry' Case Management v Cw,Jh.alelEnliv E.ed.` Noticing Note[ .ace Manepemeni Nothing Plan IFienny rnordlnalnd Fntryl warming v I inked m Ne.smlre. turner iv PPraamlm AnRRYanee rear Manar.nent Needs ninnenliMi Aswislanuv Evert Date .'nno:2:), Serece Note 5. Under the Coordinated Entry Event category, enter a Referral to Prevention Assistance project for the HoH. a. No notes need to be added in the service notes section. 11IPage Last Revised: May 31, 2024 Enrollment History Provide Services Assessments Notes Files x Cvr. Services Bed aeservation Wail List Case Management v Case Management El-amity Coordinated Entry) Case Management v Coordinated Entry Event Coordinated EMry Evert v Problem Soloing,Div rson.Rapid Resolution Intervention or service Referral to Housing Navigation project or services Referral to Non continuum services No availability in continuum services Referral to Non continuumservices-.Ineligible rei continuum services v Referral to post-placem,nt follow-up case management Referral to Prevention Assistance protect n Vail Dale 'N'':: fiW Dale 1' , Service Note , After Documentation Collection 1. if client is approved for rental assistance: 1. Exit the client from FCES 2. Enroll the client in the project assigned same day as exit date out of FCES. 2. If client does not submit a complete packet or is not eligible: 1. Exit client from FCES. Diversion Process Overview • Families Forward follows the HUD definition of Literally Homeless. • During every conversation with the client the Family Navigator will discuss and ask questions around diversion. The goal of Diversion is to assist families as quickly as possible, resulting in a less traumatic experience for families staying in a place not meant for habitation. Diversion also keeps families from waiting on the interest list (Family Coordinated Entry System Community Queue) for long periods of time. • To see if there is an opportunity for diversion, the Family Navigator will build rapport through communication and transparency. Discussions about the family's specific situation and light goal planning may assist families to identify an immediate and safe solution towards permanent housing. • Potential Questions to Ask: 1. Where did you stay last night? Would it be possible to stay there again for the next few days? What would it take for you to be able to stay there? 12IPage Last Revised: May 31, 2024 2. If you can't go back or are staying in a place not meant for human habitation, is there somewhere else where you could stay temporarily? Family members, friends, co-workers? What would it take for you to be able to stay there? 3. Are you new to the area? Could you return home? Is there anywhere else outside of this area where you could go? 4. What do you need to get permanent housing. a. Can you get help from family or friends? b. Co-signer? Security Deposit? c. Social Services? House of worship? • Diversion is an ongoing conversations and can be revisited throughout the time a Family Navigator is providing supportive services to families. • If families get approved for a unit and meets funding requirements, the Family Navigator will work on the Diversion process. • If families are unable to find an immediate solution within the first two weeks of connection, a Family Navigator can prepare the family to enter the Community Queue. • Families Forward has Diversion funds available to help divert families from the system. The Diversion funds can be used for the following: 1. Security deposits 2. Travel expenses within Orange County 3. Utilities deposits 4. Any other expenses approved by the Service Navigation Manager • If the family finds permanent housing outside of Orange County, alternative funds may be used, if available to help them secure the housing. The Family Navigator may also reach out to partners (e.g. St. Vincent de Paul, Eastside Church) to see if they can assist as well. • If the family finds permanent housing within Orange County; the Family Navigator will notify the Senior Family Navigator to determine what the best funding or route would be for the family; whether that be Diversion funds or Rapid Rehousing. • If Rapid Rehousing is deemed to be the appropriate match for the family, then the Family Navigator will schedule a meeting with the family and work with them to make sure that they are eligible for Rapid Rehousing in Orange County. At the next match meeting, the Senior Family Navigator will bring the request that the family be matched to Families Forward. The Family Navigator would then work with the assigned Case Manager to provide a warm hand off. Literally Homeless Overview Tools to identify Literally Homeless families Flowchart to Identify Chronic Homeless Status HUD Requirements for Chronic Homeless Status Checklist of Documents 1. HMIS consent forms signed by all adults 18+ 2. HMIS intake forms 3. FSC Consent forms signed by all adults 18+ 131Page Last Revised: May 31, 2024 4. Family Service Request Form 5. FSC 3rd party verification/Category 4 homeless verification completed by you a. Other 3rd party verification(s) can be included if applicable (should always be asked if a family is coming from shelter, transitional housing, or motel paid by another agency) 6. FSC self-certification - used for category 1 homelessness only. Best to use this 90% of the time so family will verify their literally homeless status. 7. Housing assessment plan (document that you will complete at client's first scheduled meeting/appointment) Additional documents to verify their LH status: 1. Disabling condition verification 2. Chronic homeless status form 3. Declaration of Homeless status form What must be uploaded and completed on HMIS: 1. Housing assessment plan 2. Refer to community queue 3. Current living situations 4. Diversion tracking tool (password: thinkoutsidethebox) 5. Bed reservation assessment and refer to bed reservation queue (only done once if family is interested in shelter) 6. Weekly bed reservations requests (if applicable, an assigned navigator will be completing all weekly bed reservation requests) This page should only serve as a support to Family Solutions Collaborative trainings and Family Service Navigation Manual. Housing programs that are mainly in Orange County: 1. Transitional Housing Program 2. Rapid Re-Housing Program 3. Housing Choice Voucher and Permanent Supportive Housing (should only be mentioned after discussing with family their length of homelessness and amount of times they have been homeless) Example scripts to use for RRH discussions: • "Rapid Re-Housing is a housing program that will assist with gradual rental assistance that can last from 3 months or more depending on the housing program opportunity." • "Once we complete the documents, your name will be put on an "interest list" for Rapid Re-Housing." o We never say the Community Queue is a waitlist, waitlists will indicate that if a family waits long enough, an opportunity will come to them. o We never want to guarantee anything to families. • "There is no specific time frame when a family will be matched, families can be matched within the next few weeks to a few months, it depends on the housing program opportunities that are open each week." 14IPage Last Revised: May 31, 2024 • "If your family gets approved for an apartment, your name can be pulled off the interest list right away to be matched for a housing program opportunity or for security deposit and first month's rent program. Whichever is the best solution for your family. Please also allow us for a 1 week turn around time frame to pick your move in date." o "When that happens, please make sure that everyone is on the lease agreement, community or landlord is willing to take a direct 3rd party check from us, and the landlord/community must be okay with providing tax documents at our request." (If it is a private landlord, they may use their social security number on the W-9. To protect the landlord, a Family Navigator will directly ask the landlord for the W-9 when needed) Key Notes: • As families wait to be matched to a housing opportunity, it is important to continue engaging with the family. The expectation is that you stay in contact with all families on your caseload at least once per week. All attempts and connections must be added as a service and case note in HMIS. • If you are unable to reach a client after making at least three (3) attempts and providing them ample time to get back in touch with you, they should be removed from the Community Queue and exited from the Family CES project. • At any point in time families are on the Community Queue, a family navigator can continue using diversion tactics to assist in the family in working on their own permanent housing solution. Managing client expectations: • Sometimes families will request specific services that are difficult to provide or are not in our capabilities. It is important to be transparent about what services that can be offered and provide realistic timelines of when they may potentially receive those services. o We will respect the client's wishes and allow for client choice within the scope of our work. • Our goal is to reduce the amount of time families are waiting for an opportunity while lessening the traumatic experiences being literally homeless. If families are coming up for an opportunity that they have denied to wait for a "better" opportunity, a discussion around the family's name coming up on the "interest list" must be held. This is to notify the family of their current opportunities to allow a potential change in accepting opportunities that their name is coming up for. See Literally Homeless Flowchart in Exhibits Rapid Rehousing History • Families Forward's Housing Program is designed to help families who have recently faced a crisis that left them homeless. Families Forward helps these families get back on their feet by providing housing, counseling, career coaching, life-skills training, and 15IPage Last Revised: May 31, 2024 referral services. Families enrolled in the program may receive rental subsidies to give them time to regain their self-sufficiency. Length of stay in the Housing Program varies from family to family. Services Provided Rapid Rehousing (RRH) and Interim (INT) includes the following types of services for families who are experiencing homelessness: Financial • Rental assistance as outlined in the Schedule of Rent Payment Assistance (SORP) form; RRH • Security Deposit; • Emergency Assistance (i.e. car repair). Financial • Temporary housing of 30 day,with the possibility of extensions up Assistance to 90 days.This is coordinated with the client's Case Manager and INT the Property Manager. • Emergency Assistance (i.e. Car repair) Case Management • Care Team is assigned to support the family for the duration of the RRH, INT program o Care team consists of a Case Manager, a Housing Partner Specialist, a Career Coach, and Counselor. Childcare • Assistance in connecting with childcare subsidy provider such as RRH, INT Children's Home Society or Head Start of Orange County;and/or • Financial assistance from Families Forward private grants. Career • The Career Program provides individual job coaching for clients of RRH, INT our housing programs to support them in maximizing their income and earnings. This is achieved with a focus on obtaining or upgrading employment, increasing market skills through training and education. • Client introductions to the Career Program are conducted at packet review by the career coach. Counseling • Referrals to Families Forward Counseling team for mental health RRH, INT services. • Client counseling sessions are held weekly, or as needed, with professionally trained and credentialed counselors. In these sessions, counselors will provide short-term counseling to help the client attain and sustain their desired outcomes.The typical case length is 3-4 months. Food Pantry • All active Housing Program families have access to the RRH, INT food pantry once a week until the exit of their program.These 16IPage Last Revised: May 31, 2024 families must complete a food pantry form and submit it no later than Monday 9AM. • Graduated housing clients can register as a pantry client. Pantry clients can access food every week through the food pantry. Financial Literacy • Monthly budget review RRH, INT • Referrals to Financial literacy resources, including o Sparkpoint o Green Path Financial o Financial Planning Associates of OC Referrals RRH, INT • Referrals and resources as needed Seasonal Programs • For Goodness Cakes RRH, INT • Back to School • Thanksgiving Basket • Holiday Wish (December Holidays) Intake Process 1. Every week, the Housing Program Manager will receive matches from CES based on the housing opportunities submitted from the previous week. This information is uploaded to the "RRH Caseloads" Planner application in Microsoft 365. 2. Housing Program Manager and Housing Partner Manager will assign Case Manager (CM), Housing Partner Specialist (HPS) and grant for the weekly matches. 3. Case Manager will call client within 24-48 hours for introduction of program and next steps to complete the program enrollment process. a. Case Manager schedules intake based on family's needs and schedule i. example's include flexibility in location and time b. Families that have been matched to Families Forward and Case Manager is unable to connect with will be returned to CES. 3 attempts with 3 different forms of communication (i.e. text, phone call, email) will be attempted prior to those families being returned to CES. c. Case Manager will document progress of intake on HMIS. i. If family is not responsive or eligible for matched housing intervention the case manager and housing program manager will work to get the match returned to FCES ii. Family's original access point will be contacted to help re-connect to the system d. If eligible family will be returned to FCES for additional opportunitiesHousing Program Manager will check in with the Case Managers on a weekly basis to gather this information. 4. Case Managers will request Intake documents from client and provide a deadline. a. Intake documents include i. IDs for all adults 17 ' Page Last Revised: May 31, 2024 ii. Social Security Card iii. Current pay stubs (last four), proof of any other form of income (i.e.: unemployment, disability, SS Notice of Action, etc.) iv. Bank Statements (last 3 months) v. Homeless Documentation (i.e.: motel voucher, emergency shelter or agency letter) vi. City Tie Documentation (If applicable) vii. b. Rapid Rehousing requirements only included (no additional criteria for eligiblity) i. Homeless certification and documentation ii. Basic demographic information iii. City Tie Documentation (if applicable) 5. Case Managers will schedule and complete intake documents with the family. This includes completion of: a. HMIS Intake forms b. HMIS Consent forms c. Program intake documents d. Family Cover sheet 6. Case Managers will create a client file in SharePoint. File will be organized as outlined by the HP File index. 7. Case Managers will assign Data Team staff on planner so eligibility documents can be reviewed based on grant compliance standards. 8. When file is passed, Case Managers will submit a Rapid Rehousing Data Request form through Google forms. 9. Case Managers will do a warm hand off to assigned Care team members. Family Meetings Family meeting intervals may vary family to family. Our goal as a program is to be available for families as they reach out and connect with us. We strive to connect with families weekly but only require a once-a-month connection with the case manager. All other resources and program connections are made available to the family but are not a required part of the program. To guide the case management team, we ask that you create a Family Plan with each family enrolled in the program. This plan is client driven goal setting, goals established and identified by the family based on what best meets their needs. Pending • Connect with the family at a minimum every week, email communication with pending family counts as a check-in (15-30 minutes) • Check in on where they are staying, if they need access to shelters or need a shelter bed reservation • Provide updated housing opportunities and to get updates on housing leads already provided. • Check in on any resources they may need, if we have provided resources have, they been successful at connecting with the resource. If not, how can we help bridge the gap? 18IPage Last Revised: May 31, 2024 • Discuss how their jobs are going and if they are still employed, request paycheck stubs and bank statements for the month Housed • Meet at least once a month in person o Review Family plan o Discuss family progress towards areas of focus o Discuss barriers (new or existing) o Refer family to appropriate resources o For"pending" clients, discuss progress on housing search and employment status if unemployed • Complete Self-Sufficiency Matrix in appropriate intervals • Collect previous month's budget o During monthly meeting review client's budget in detail o Refer family to Financial Literacy if needed • Collect rent receipt o For RRH By the 3rd of the month o For interim on or before the 1st of the month • Send out utility bills (Interim) o Collect utility bill payment o 2 weeks from when CM sent out payment/reminder o Amount due for utilities: $ • Collect previous months paystubs • Send out check requests (via PandaDoc) for FF rent portion (RRH) • Complete accounting Excel sheet for check run • Check requests must be submitted by 11AM every Tuesday or Thursday Government Grants • The following grants contain most of the funding available to serve our families. For a current and active list of grants, refer to the Government "Grants Tracker with Scope of Services" (GT SoS) found in Data SharePoint > 02. Grants > 02. Grant Tracking Meeting. ESG Grants • Each ESG funding source has some unique allowable criteria for eligible households. • All ESG funding applications will be referred through the Service Request Form through the Families Solutions Collaborative. The collaborative offers a coordinated approach to requests coming in by Service Planning Area: North County, Central County, and South County. Within the Service Planning Areas different access points are assigned cases based on region. • Once a referral is received and the Family Navigator connects with the family, they complete a Prevention Assessment Tool to aid in determining baseline eligibility and prioritization. Families that score greater than or equal to 12 are eligible to be considered for ESG funding opportunities. 19IPage Last Revised: May 31, 2024 • Families that are screened through Prevention assessment tool and score in the appropriate range move on to eligibility review. This requires families and Family Navigators to work together to collect required grant and program documentation (see File Index— Prevention & Diversion) The Family Navigator is required to collect and review all documents listed below in accordance with ESG regulations to ensure compliance and eligibility of cases using ESG funds; the Data and Compliance team will also review files for completeness. Any issues with unavailable documentation will be reviewed by the Leadership Team to determine the ability to move forward with the financial assistance request or to determine ineligibility. ESG Prioritization and Intake Families Forward leverages processes in the Continuum of Care, following HUD regulations for prioritization, intake and assistance determination. 1. Families complete request for services form established by the Continuum of Care and the Families Solutions Collaborative 2. Based on current living situation family is routed by the system to resources defined by HUD as literally homeless or homeless prevention. 3. FF staff will then complete the Prevention Assessment Prioritization Tool to identify scoring mechanism equaling or greater than a score of 12 a. Families in the scoring range appropriate for support and prioritization are moved along to eligibility stage ESG Eligibility 1. Utilizing the documentation checklist all participants prioritized for homeless prevention funding must present needed documentation in order to deem the applicant eligible for services under the ESG grant 2. Documentation and record must include a. Program participant meets the criteria of the "at risk of homelessness" definition b. Income documentation to determine Annual income to establish Area Median Income i. FF staff will collect 3 paystubs for families to calculate AMI 1. If 3 paystubs are not available FF staff will continue process application with 1 paystub or any level of eligible documentation mention in section ii 2. If paystubs are not available comparable proof can be collected including tax return documents, letter from employer ii. If proof of income is not available in any form FF staff will collect a self- declaration of income from participants declaring that there is no income or income without available proof c. Records that indicate that the participant lacks the financial resources and support networks to attain housing stability i. The most reliable evidence available to show that the program participant does not have sufficient resources or support networks; e.g., family, friends, faith-based or other social networks, immediately available to 20IPage Last Revised: May 31, 2024 prevent them from moving to an emergency shelter or to maintain stable housing includes 1. Source documents (e.g., notice of termination from employment, unemployment compensation statement, bank statement, health- care bill showing arrears, utility bill showing arrears) 2. To the extent that source documents are unobtainable, a written statement by the relevant third party (e.g., former employer, public administrator, relative) or the written certification by the recipient's or subrecipient's intake staff of the oral verification by the relevant third party that the applicant meets one or both of the criteria of the definition of"at risk of homelessness" 3. To the extent that source documents and third-party verification are unobtainable, a written statement by the recipient's or subrecipient's intake staff describing the efforts taken to obtain the required evidence; and the most reliable evidence available to show that the program participant meets one or more of the conditions of the definition of"at risk of homelessness" 3. VAWA protections a. The core statutory protections of VAWA that prohibit denial or termination of assistance or eviction solely because an applicant or tenant is a victim of domestic violence, dating violence, sexual assault, or stalking applied upon enactment of VAWA 2013 on March 7, 2013 The VAWA regulatory requirements under 24 CFR part 5, subpart L, as supplemented by this section, apply to all eligibility and termination decisions that are made with respect to ESG rental assistance on or after December 16, 2016. ESG Transportation Policy • Costs of travel by program participants to and from medical care, employment, childcare, or other facilities that provide eligible essential services are eligible. Staff travel costs incurred to support the provision of essential services are also allowable. • Eligible costs include: o Cost of program participant's travel on public transportation o Mileage allowance for service workers to visit participants Prevention Irvine ESG • Irvine ESG is Prevention funding available to families that either live in Irvine or have a tie to the City of Irvine. The funding allows for short to medium term financial assistance, either arrears or current rent. The AMI requirement is 30%. • There is a required case management component. This requires the Family Navigator to schedule a case management conversation with the family while providing rental 211Page Last Revised: May 31, 2024 assistance. This meeting will include reviewing and completing a monthly budget, goals, and providing any additional resources that could best assist the family. Families Forward General Prevention and Diversion Funds • Families Forward has limited funds available for families that are in need. These funds can be used for families that are not eligible for the other funding opportunities we have to offer. The funds can be used for a security deposit to divert a family or for one month worth of rent. • Program staff must case conference with their supervisor to ensure all funding sources have been exhausted. After management approval, amount of assistance is dependent on availability of funds. • There is no case management component tied to these funds. • Note: P&D Flex Funds/General Funds do not need verifiable city tie documents. SAUSD • Referrals to Families Forward comes through Santa Ana Unified School District (SAUSD). • Through the partnership with SAUSD, funds will be used to provide case management, housing navigation services, motel vouchers, and other direct, wrap around services, to eligible families referred to Families Forward by Santa Ana Unified McKinney-Vento Liaisons. Each family is triaged, and an action plan is created to ensure the greatest success for each family. Rapid Rehousing County of Orange RRH+ Families served under the County of Orange RRH+ grant receive financial assistance for 3 to 24 months. Financial assistance is dependent on the family's needs. To be eligible for this grant, clients must meet the following criteria: • Meets HUD criteria for defining homelessness, categories 1 and 4 AND • 30% AMI — 50% AMI (prioritizing 30% AMI or lower) Housing Choice Vouchers (HCV) Housing choice vouchers are designed to support families experiencing homelessness become self-sufficient. These opportunities are matched during the Family Coordinated Entry System match meeting. HUD Families served under the HUD grant, receive financial assistance for 3 to 6 months. Financial assistance is dependent on the family's needs. To be eligible for this grant, clients must meet the following criteria: • Provide a 3rd party verification of literal homelessness AND • Be referred through the Family Coordinated Entry System (FCES). 22IPage Last Revised: May 31, 2024 Strong Families Strong Children (SFSC) The Strong Families Strong Children collaborative works with military connected families. Every team member within the collaborative is either a Veteran or Military connected. SFSC is comprised of 5 organizations in OC that work with Military connected families: • Human Options— Domestic Violence counseling • Families Forward — Housing navigation, case management and trainings • Child Guidance Center—Children counseling • Veteran Legal Institute— Legal affairs • Children and Family Future— Data and evaluator of the program Tenant-Based Rental Assistance (TBRA) Costa Mesa TBRA In partnership with the City of Costa Mesa, Families Forward assist families experiencing homelessness or at risk of experiencing homelessness. To be eligible for this project, families must meet the following requirements: • Have strong city ties like: o Currently homeless in Costa Mesa, o Employed in Costa Mesa, o Children attending school in Costa Mesa, OR o Previous or current permanent residence in Costa Mesa • Currently Homeless or At-Risk of Homelessness • Complete City's Intake process: 1. TBRA application 2. Declaration of Homeless or At-Risk of homelessness status • Income eligibility/AMI requirement o Low-income households established annually for the HOME Program by HUD (incomes at or below 60%AMI) with a severe housing cost burden (housing costs equal to 50% or more of their monthly income) • Gross Annual Income means the gross amount if 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. See Step 4c and 4d under Intake Process for documents obtained. • Eligibility Verification o Families will be re-qualified (Step 4c and 4d for documents obtained under Intake Process) every six months • Waiting List—Once project has reached maximum enrollment, a waitlist of prospective eligible households will be maintained. The list will be prioritized as follows: o Clients who are eligible, completed intake process from above and ready for housing placement (meaning the family has found a housing unit that meets TBRA requirements) 23 ' Page Last Revised: May 31, 2024 o Clients who are eligible, completed intake process from above and are searching for housing o Clients who are eligible and pending intake process from above o Priority ranking will be given for Homeless Category 1 • For all Costa Mesa TBRA Policies and Procedures, click HERE Huntington Beach TBRA Families Forward works in partnership with the City of Huntington Beach to provide housing services to families experiencing homelessness or at risk of homelessness. To be eligible for this project, families must meet the following requirements: • Have strong city ties like: o Currently homeless in Huntington Beach, o Employed in Huntington Beach, o Children attending school in Huntington Beach, OR o Previous or current permanent residence in Huntington Beach • Currently Homeless or At-Risk of Homelessness • Complete City's Intake process: 3. TBRA application 4. Declaration of Homeless or At-Risk of homelessness status • Income eligibility/AMI requirement o AMI of 60% or lower ■ Gross Annual Income means the gross amount if 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. See Step 4c and 4d under Intake Process for documents obtained. • Eligibility Verification o Families will be re-qualified (Step 4c and 4d for documents obtained under Intake Process) every six months • Waiting List—Once project has reached maximum enrollment, a waitlist of prospective eligible households will be maintained. The list will be prioritized as follows: o Clients who are eligible, completed intake process from above and ready for housing placement (meaning the family has found a housing unit that meets TBRA requirements) o Clients who are eligible, completed intake process from above and are searching for housing o Clients who are eligible and pending intake process from above o Priority ranking will be given for Homeless Category 1 • For all Huntington Beach TBRA Policies and Procedures, click HERE 24 IPage Last Revised: May 31, 2024 Private Funding and Other Funding Make a Difference This fund is set up to provide support for families that do not fit under our grant funded sources. Submissions are discussed and reviewed by the program management team before it is submitted to private funder. Examples of previously funded expenses are: • Education or training expense • Car repair Nancy Chase Families can be assisted with the Nancy Chase fund to cover child related expenses. Examples of previously funded expenses are: • Childcare • Beds for children • Car seat • Enrichment activities such as after school programs or sports Financial Assistance ESG Assistance 1. Once a participant is deemed eligible under sections ESG Prioritization, Intake, and Eligibility and approved for the program FF staff will create a "Schedule of Rent Payment" document to inform the participant of level of financial assistance that will be provided 2. Financial assistance is determined by an FF staff member by: a. Reviewing ledger for allowable costs including rental amounts due, utilities owed, client payments, and length of rental arrears b. Amount of assistance per family by setting a baseline calculation of total amount of financial assistance available and number of households in the scope of work i. This allows the staff to determine maximum amounts of assistance per participant in order to stay within grant deliverable c. There are some occasions where a household does not have sufficient allowable costs to reach the maximum allowable costs, the remainder funds are re- allocated to service additional families beyond the scope of services or to re- allocate to households that need to be considered for funds beyond the maximum allowable amounts i. Total amounts spent are reviewed and reconciled monthly and new maximum allowable amounts are established for the program ii. The FF team will continue this review process until the scope of services of households is served and financial assistance is fully expended iii. FF ensures that length of program standards for ESG programs are followed 25 ' Page Last Revised: May 31, 2024 P&D Assistance • These documents below are collected for most city funding grants. However, some city funding grants will require an additional Prevention Assessment Tool and an FCES Prevention Process. Needs FCES Prevention Process Does not need FCES Prevention Process • Irvine ESG • P&D Flex Funds • Request of rental assistance is used to pre-screen eligible families through Planner's comment section. • Initial steps for rental assistance: o Create file request and add to email template o Send email template with added due deadline o Send PandaDoc template • Timeliness: o Deadlines are given within 3 business days and has a potential extension to 2 extra days. If family does not send in any documents into the File Request folder, Family Navigator may exit family and share they can re-apply to the program as long as funding is still available. o However, if family has sent in most documents, there is flexibility for family's case to stay open. It is on the Family Navigator's discretion to keep families open. o Be mindful for how long family's rental assistance case is open, due to documents going out of date after long periods of time. City Funding Email Template Spanish version can be found in files. Data and Compliance Data Systems • Data entry is entered in CiviCore (NeonOne) and/or the OC Homeless Management Information Systems (HMIS). CiviCore (NeonOne) • CiviCore (NeonOne) is an information database system we utilize to collect client information and record the services we provide to our families. • For a quick overview of data entry into CiviCore, click here: CiviCore Manual HMIS (Clarity) • HMIS is a local information technology system required by HUD and used to collect client-level data and data on the provision of housing and services to homeless individuals and families and persons at risk of homelessness. • All data entry into HMIS must be within 3 days. 26IPage Last Revised: May 31, 2024 Services and Notes Always click on edit button of project to enter all case notes and services ■ IIr vm ='2C Active Services Examples 1. Under Provides Services tabs, add service by submitting an empty Case Management service. Start Date and End Date are the same day. E-sOarnent Hnrpy Prasde Services ds<.•= • Services Housnq Notes Case Managwrese�. IHP Iron FSoi Frrwgencs rood Good 1HP Iron.FSOI Fs-uncial Asnnlanca 'manna!v IHP Irene FSni Gas Cord rramprrtaom �i1P Imne FSoi Ho-Jung StaWdy Wan ,ouranq SIP Irvin ESOI SlappMNe ServKvs -napenrM�. Career v Case Aranspsnwt Start Date 'r 112021 End UM* M 152C21 Time Trad i g- Norrt Nc+,. were?Ott. • SUBMIT 2. For rental assistance, please use individual services for each month that we are assisting with. The general rule of thumb is to use the check date if cut after the 15t of the month and the 15t of the month if the check is cut before the 15t of the month. o Examples: 1 Requesting a check in December January RA service date:1/1/XX-1/31/XX No note necessary for January rent 2 Requesting a check in December December RA service date:12/3/XX-12/3/XX(check date) No note necessary for December and January rent January RA service date:1/1/XX-1/31/XX No note necessary 3 October RA service date:12/3/XX-12/3/XX(check date) Service note:October back rent 27IPage Last Revised: May 31, 2024 November RA service date:12/3/XX-12/3/XX(check date) Service note:November back rent Requesting a check in December December RA service date:12/3/XX-12/3/XX(check date) No note necessary for October-January rent January RA service date:1/1/XX-1/31/XX No note necessary Case Notes 1. Once service is completed, under Notes tab use "Add Note" to add case notes that match the service date. 2. Case Notes Title: a. Eligibility Note b. Attempted to Contact c. Connected with Client: Phone/Email/In Person/Virtual Meeting d. Client Left Voicemail e. Resources Data Deadlines New family data • All families need to be entered into HMIS within three days of enrollment date, which means date that client was verified eligible for RRH. Services • All services need to be entered into HMIS within three days of rendered service date Exiting Families Upon Completion of Program • All families need to be exited from HMIS within 3 days from moveout date/last day the month in which client received rental assistance. Case Notes • Case notes need to be entered no more than three days after family meeting • Case notes are required for the following: o Entry of the family into housing case note o First family meeting case note o Family meeting case note for each month in the program o Gift card services provided o Emergency with client, family or home (entered immediately) o Information or interaction CM feels important to document o Exit case note Note that "Three days" means three calendar days, not three business days. So as an example, if enrollment date occurs on a Friday, they must be entered by Monday. Family Navigation Caseloads Management • FN Caseloads can be found on Families Forward's Sharepoint under: 28IPage Last Revised: May 31, 2024 o Programs > Family Navigation > Client Files > Caseloads o Used to keep track of each Family Navigator's caseloads to assist Senior Family Navigator in assigning cases. Forms • Forms can be found on Families Forward's Sharepoint under: o Programs > Family Navigation > FN Documents o The folder is organized by housing type Client Files • Client files can be found on Families Forward's Sharepoint under: o Programs > Family Navigation > Client Files o The folder is organized by grant o Refer to File Index— Prevention & Diversion for a checklist of documents per client file Rapid Rehousing Forms • Forms can be found on Families Forward's Sharepoint under: o Data Department > 00. Entry and Exits Dropbox > 1. Original Consent & Packets > Rapid Rehousing Docs Client Files • Before creating the file make sure all documents provided are filled out and up to date • Case manager will create file in SharePoint • All files are saved in the Data subsite>Data Documents>00. Entry and Exit Dropbox>2. Client Files • Select grant that the client will be served with • Create new file with client name, in the following format: o Last Name, First Name o Use the Head of Household • Create sub folders with the following titles: o I- Eligibility o II- Personal o III- Housing o IV- Case Management o V- Program o VI- Exit • Use Housing Program (HP) File Index as a guide for proper placement of documents within file Maintaining Record Keeping • The following items are required to be filed regularly: o Budgets 29IPage Last Revised: May 31, 2024 o Paystubs o Home inspection forms o Gift card verifications o Correspondence with client o Pertinent information that would affect their housing program o Change in child support income letters, court letters, cash aide award letters, etc. • Documentation of each program participant's qualification as a family at risk of homelessness or as a homeless family and other program participant records must be retained for 5 years after the expenditure of all funds from the grant under which the program participant was served. • Files/Records are secured behind password protected servers and/or secured in locking file cabinets in an office that is locked. Best Practices Caseloads • Family Navigators will keep a current caseload of a maximum of 25-30. Caseloads are tracked by using Notion that can be found through the Family Navigator portal. A Family Navigator is responsible to keep their caseload updated on a weekly basis. • New clients will be entered and assigned onto Notion by the Senior Family Navigator. 30IPage Last Revised: May 31, 2024 Exhibits Prevention Flow Chart Prevention Flow Chart Family Is not eligible for rental assistance but at risk After 2-3 attempts,.. of homelessness.have family from diversion discussions and FN will make 1st provide resources SFN/SNM receives attempt/contact and submit )Can offer s.i..•..•.a•; Service Request Form —_. CiviCore data request within ,_ 1st contact confirm assistance requr Knents) and assigns FN or PSV a business days of receiving client's current living SRF.Use planner to notate 1st situations.city ties.and _ j ,,. attempt/case rate services requested. Follow up with family for 1- Family can be given 2 day 2 weeks If resources have extension.If no response or Once family has passed If faintly needs rental been exhausted,notify missing documentation,close eligibility review.send email assistance,complete Request family of exit and to roach case.exit family from CiviCore template&file request for of Rental Assistance back out when future and notify family can re-apply potential grant to collect '- template.move to r---- assistance is needed when they are ready. documentation .. appropriate bucket.and assign SNM on planner. I - r Collect all documents,forms. link file in Planner.comment After 1st review,SFN/SNM Complete last services and signatures and organize files ready for data review.move will complete end review and case notes then complete If When most documents are - task to appropriate bucket. -e Complete Lead Screening. CiviCore data request to exit mostly completed,complete and assign Community security deposit assistance, HMIS intake forms. Resource Coordinator, HRS complete Rent Reasonableness. • (If applicable)Submit career Upon final approval received . Cant partially approved,submit NOTE If family becomes LH referral to SNM if client from SFN/SNM.send SORP and data request for enrollment into anytime within this process. needs career services. other dots through DoeuSign _ HMIS when instructed.obtain please exit family from Connect wrtn for signatures.Contnrct client A r ledger,and complete SORP CiviCore and start LH throughout cite^t;case• ...,.. .•i..-,.,.� ' ' .•.•`,T_5 r-rc•ventan process management meetings , . ,I applicable i Complete family meetings If client Is needing more rental Conduct exit interview after for length of time of financial assistance.case conference with resources have been exhausted. tn past*., assistance through budget& y SNM-If client is eligible.obtain After 2-3 attempts and client is goal setting Send resources updated ledger and submit SORP unreachable.notate attempts in fN&Ci.ent if needed.Complete all case for SNM review.Upon approval. HMIS and submit data request to .HMIs/CrviCore notes and services In HMIS send dots through DocuSign. exit family aeteuea 31IPag Last Revised: May 31, 2024 Literally Homeless Flow Chart Literally Homeless Flow Chart Complete HMIS intake After 2 attempts,exit packets and send LH ' family off caseload doeurrients through FN receives Family i DoeuSign to family Service Request • FN attempts to contact ` family. 1st contact confirm Form/Referral. client's LH status and Submit data request for complete intake HMIS enrollment after process signatures Project start FN follows up date of enrollment is the date of signature. within i week r- (Can submit data request Transfer HAP.VI-SPDAT, w/out signature if urgent) k - and complete Current living Situations Family identifies unit • Family is unable to find a a Diversion Tracking Tool with unsigned lease in diversion solution,explore and services&ease Upload LH does under hand or diversion files tab and complete alternative to get out of Transitinoal Housing.Rapid notes, phone appointment homelessness. Re-Housing,or potential (Housing Assessment Plan, HCV/PSH VI-SPDAT,and discuss Diversion or other family Collect docs and follow 1 Z needs(shelter) process for FSC IInterested in 1 Diversion or D. Interested in THP Interested in RRH HCV/PSH • Malst&1MF _. _ Needs shelter Follow Shelter CO 1 [— -` recess.but mark Add to FCES CO. Collect docs to be Approved for Diversion P HCV/PSH read y 1 funds and family is THP&send THP and add family to i Pending Complete Bed resources Once matched FCES CO. on Resarvadon successfully diverted . Complete HMIS tasks then outsides of FCES Shelter wont If family is warm hand off to co of shatter.Add exit FF CM or Housing family to Shelter CO. Once matched. Program Provider Once matched, warm hand off to cM warm hand off to THP FFCMorPSH we,'nMa uk.sse provider. Complete weekly bed reservation request FNa Client ---_---�-- -- SFN/SNM wilt Warm hand off family to next Access I Family is connected to shelter •....es Nested Point.Family's case transfers complete in HMIS 32IPage Last Revised: May 31, 2024 SAUSD Prevention Flowchart Santa Ana Unified Flow Chart Family ri not Migihie for T. rental assistance but at risk (Prevention) f of homelessness have diversion discussions and SFN/SNM receives FN will make 1st tit contact confirm client's provide resources referral from School attempt/contact and submit current living%duations a.v,o•',,, •c t inn. -•goo• District or School .—•► CiviCore data request within Santa Ana be,referral party. .x<i`tance mgieierneel,d Personal.Will assign FN a busmeas days of receiving and services requested g SRF Use planner to notate Complete intake forms and J • 1st attempt/case note send for signatures — Once family has passed Follow up with family for I- li review send rinsed If family needs rental z weeks H resources have templates file request for send Data Request to potential want to collect assistance.complete Request Sen enroUtartkl eIto SAUSD �— been exhausted notify documentation C.lev is w+tt have `—. y of Rental Assistance family of exit and to reach Will need intake Forms to r.ty�,, ,,:,dryrtc.xlliM template.move to back out when future appropriate bucket,and enroll assistance is needed. • _ assign SSW on planner FitcnAy can be given 1 day_ extension If no response or missing documentation,close caw.colt family from SAUSD After 1st review.SFN/SNM and notify family can re-apply t.lrtk ate M Planner,comment will complete 2nd review and Complete lest services and when they me inertly. ready for data review.move cafe notes than complete . _ . two to appropdte bucket ._. complete Lead Screennrrng.N t CiviCote data request to exit !' and assign Community security deposit assistance. t Collect all documents,forms, Resource Coordinator SIRS will complete Rent _L. `- signatures arid organise files Reasonableness ___ (If applicable)Submit career Upon final approval received Case partially approved.submit NOTE If family becomes LH raf.rral to SNM if client from SFN/SNM send SORP and data request for enrollment into anytime within this process_ needs career services other docs through Doc uSrgn HMIS when instructed.obtain please exit family horn Connect with Career Coach ~ for signatures ledger.and complete SORP. CiviCore and start LH throughout client's case Conpletr F!'FS Prevention process management meetings Pr,.., 'niG#Hff li Complete family meetings If client is needing more rental Conduct exit Interview atter for length of time of financial assistance,case conference with nfot+c.s have been exhausted. In Pre*. assistance through budget& SNM.If ctMM Is religlbie,obtain Agar I-3 attempts and client is goal setting Send resources updated ledger and submit SORP unreachable,notate attempts In FH I Clint if needed Complete aU case for SNM review,Upon approval. HMIS and submit data request to .ianr5/CrvmCore notes and services in HMIS send docs through DocuSigrt exit family. awanw 33 Page Last Revised: May 31, 2024 SAUSD Literally Homeless Flowchart Santa Ana Unified Flow Chart (Literally Homeless) _.A " , 1 l SFN/SNM receives FN will make 1.1 Motel No Motel referral from School a eotntict r.Ltrn,nr Needed Needed ttOmpt/ 1st contact confirm client's Distnct or School le notate st ay.--,r•Cosa* current living situations, Personal Wilt assign FN naic, rererrel party and services requested Santa Arm tie — Rook motel for one and need for motel. week reservation Complete intake forms Confirm with motet whin the latest Send dada request tosser* Begin Diversion Conversation, check in client into SAUSO and FOES complete intake forms and b:. yr.., Fn well roach Out to referral once pocket and intake.is send Intake packet for 'rkfcnrodf staff and notify thorn of signed.Co l signatures contact with client Tracking�'^.kar3 fk3o,will . ix+ entered inre SAUSD riteruct .. _ If family needs extension Complete VI-SPAOT.Housing within their first week.FN will Upload Third•Party Assessment Plan,and Shelter notify both SFN and SNM Verification and any LH Assessment N needed.Refer about the request.Once SNM documents to HMIS under top Community Ououe approve.SFN will extend Files tab reservation Attend weekly Match NOTE Meetings. Discuss housing Input any service notes into HMIS opportunities with client and and continuo Diversion provide any additional Conversation resources if needed • FAMttieS FORWARD Once client is matched they '.Pi aesecsr will be re-assigned to Housing Provider Mike swe FN•c:wrr new CM is assigned on HMIS.. i IW1S/Co*Cer. Rrnakrd 34iPage Last Revised: May 31, 2024 Prevention Assessment Tool Client POI Name-- COVID Affected? ❑Yes ❑No Client Address: Grant Requesting: City tie(s): Is everyone in the household including children listed on the rental agreement or Do you rent? lease? /I Yes No ■!Yes No Can you pay rent next month? Do you receive any housing subsidy? Yes r:No _Yes f+l No How will you sustain your rent after potential Did you receive assistance?(Provide monthly income) .Pay or Quit notice? Date on the notice received: Are you behind on rent? Eviction notice? Yes Date on the notice received: How many months are you behind? M of undocumented individuals: What is your monthly rent? Owed Rent Total? No Other Comments: 3 Has moved because of economic factors 2 or more times in the last 60 drys 3 Household with dependent children 0-17 3 Household with current pregnant woman 3 Household will be lost within 14 days 3 Household will be lost within 21 days 3 Domestic violence or abuse in household 3 Household is under 50%AMI 2 Household with a senior,65 years or older yCy!s 2 Household with an individual convicted of a felony 2 Someone in the household has a mental or physical disability and/or circumstances that affect homaeg 2 History of previous evictions 2 Sudden and significant loss of income,employment,cash benefits and/or sudden increase in expenses due to medical or family emergencies 2 Have been out of work for 3.months 2 Applied for shelter and spent at least one night during the prior 60 days literally homeless 1 Rental and/or utility arrears 0 TOTAL POINTS(Scores<12 are ineligible for services.) P&D Prevention Assessment Tool April 2022 35IPage Last Revised: May 31, 2024 File Index — Prevention & Diversion FAMILIES FnRWARD FILE INDEX Hot Family Navigator Grant Tab I-ELIGIBILITY Addttiond information. ❑❑O.HP File Index ❑❑I.HMIS Consent Form H" ❑❑lb.CESAutttortation Form(Irvine ESG only) Household names&Ages. 002 HMIS Intake Forms 003.Adult Identification(s) Naid CA d) 004.Social Security Card(s) 1305 In one Guidelines OM Income calculation works heet O 0 Income Verifrcabon(3 most recent,consecutive poystubs/benef ts) All income verification shown as transactions Dsect deposit.account number matches bark statements Address. Receiving benefits-if not in transactions.a statement on receivd Q]8 Bank Statements(2 months ci bank transocbans) Statement clarification for transactions above S10O0•OR rnutbpie questionable transactions 029 Duplication of Benef its 0010.Program Contract Doll Grievance Policy Source of income 0,]12 Verifiable City Tie-Document d Monthly income. AddeOnal documents to verey need(include as many os oppkable) AOO? 0❑13.COV1D-19 How ore the., moocted by COILID-siilI today 0013b.Goal Setting Tab II-HOUSING 001 Communicoban Disclosure I certify that I have executed a thorough deck for 0132.Schedule of Rent Payments potent a. fraudt.ient actrvrtes and obtained any Highlight morith(s)of assistance needed bark transaction ceebhcabonsto the best of ❑❑3 Lease Agreement my knowledge. Highlight occupants.lease terms,&rent amount Potential additional documents needed: F hi Initial: ❑Month to month verification 0 Additional individuals/children SNM Initial a Addendum.lease.or verification of changes in rent a Co-signer/individual nonresidency clarification Date: o OCH./housing subsidy documentation 00 4.Ledger 00 5 Pay cx Quit Notice(Highlight month(s)of assistance) ❑❑ 6 W-9 from vendor Signed 2018 W-9 docurnert.dated »r: cl=1 7.HUD Inspection(ESG.HAS.Rent reasonable)(IMM ESG asig) Ix]8.Lorillard Contract Tab I II-EXIT 1:31.HMIS Exit Forms m2.Exit Income Vedication [1:33.bit Self-Declaration of Income Fr SNM or SFN use only Date fie approved, Date of data request Revered 10.2023 Data Request Approved? Yes 36IPage Last Revised: May 31, 2024 File Index - Housing Program (HP) FAMILIES FeRWARD HOUSING PROGRAM FILE INDEX Tab I—Eligibility Tab II-Personal -HP File Index Setf-Declaration of financial Resources HMIS Consent Form —Bank Statements-3 months HMIS Enrollment Forms School Enrollment Verification(5+years) Homeless Certification Birth Certificates-all household members —31°party verification of homelessness _Medical Insurance Cards 'Proof of City Tie -CaIAIM Consent Form —Picture ID —Court/Custody Documentation(If applicable) Social Security Card "Disability Documentation(If applicable) Divider Entry Income Guidelines `'Entry Income calculation worksheet 'Entry Income Verification(3 stubs) —Self-Declaration of Income Tab III—Housing Tab IV—Case Management Rapid Re-Housing —CTI Plan —Schedule of Rent Payments Ongoing Income Verification 'Signed Lease "Monthly Budgets Rent Receipts or Ledger Self-Sufficiency Matrix —Key Exchange Agreement FF Motel Reservation forms(If applicable) ESG Lead Screening Worksheet —Purchase Authorization Request(If applicable) Rent Reasonableness Checklist and Certification Client Email Correspondance Minimum Standards for Permanent Housing 'Crisis Documentation(If applicable) •Housing Inspection Forms —Employment Agreement(lf applicable) fESG Landlord Agreement Letter Sample (RRH+) TBRA(CM&H81 HB TBRA "'CM TBRA Lease Addendum(VAWA) HB TBRA Application for Rental Assistance CM TBRA Home Rental Assistance Program Contract NB TBRA Home Rental Assistance Program Contract Career Divider-Interim Housing -Intenm/TH Lease Agreement —Rent Amendment —Exhibit A Rental Formula —Misconduct Act —Housing Inspection Forms(If applicable) —30-Day Notice/Extension —Security Deposit Return Termination of Housing Process of Appeals Tab V—Program Tab VI-Exit Both Programs HMIS Exit Fomis Program Offer Letter Exit Income Guideline, 'Termination of Assistance Policy -Exit Income calculation worksheet -Termination of Assistance Policy (RRH+) EXII Income Verification(3 sfts) Communication Disclosure —Self-Declaration of Exit Income Program Contract "'Grievance Policy Consent to Exchange Information Consent for Services Tenant Screening Form(If applicable) "Credit Report (If applicable) EXIT REVIEWED BY: "Background Check Disclosure —Printed background check EXIT DATA ENTERED BY: ENTRY INDEX REVIEWED BY: ENTRY DATA EPTTERED BY: 37IPage Last Revised: May 31, 2024 Exhibit A—Appendix K Addendum to Operating Procedures for the Tenant Based Rental Assistance Program NOT APPLICABLE Exhibit A - Appendix L Emergency Transfer Plan and VAWA Lease Addendum 4 VIOLENCE,DATING VIOLENCE U.S.Department of Housing OMB Approval No.2502-0204 OR STALKING and Urban Development Exp.6/30/2017 Office of Housing LEASE ADDENDUM VIOLENCE AGAINST WOMEN AND JUSTICE DEPARTMENT REAUTHORIZATION ACT OF 2013 TENANT LANDLORD UNIT NO.&ADDRESS This lease addendum adds the following paragraphs to the Lease between the above referenced Tenant and Landlord. Purpose of the Addendum The lease for the above referenced unit is being amended to include the provisions of the Violence Against Women and Justice Department Reauthorization Act of 2005 (VAWA). Conflicts with Other Provisions of the Lease In case of any conflict between the provisions of this Addendum and other sections of the Lease, the provisions of this Addendum shall prevail. Term of the Lease Addendum The effective date of this Lease Addendum is . This Lease Addendum shall continue to be in effect until the Lease is terminated. VAWA Protections 1. The Landlord may not consider incidents of domestic violence, dating violence or stalking as serious or repeated violations of the lease or other"good cause"for termination of assistance, tenancy or occupancy rights of the victim of abuse. 2. The Landlord may not consider criminal activity directly relating to abuse, engaged in by a member of a tenant's household or any guest or other person under the tenant's control,cause for termination of assistance,tenancy, or occupancy rights if the tenant or an immediate member of the tenant's family is the victim or threatened victim of that abuse. 3. The Landlord may request in writing that the victim,or a family member on the victim's behalf,certify that the individual is a victim of abuse and that the Certification of Domestic Violence,Dating Violence or Stalking,Form HUD-91066, or other documentation as noted on the certification form, be completed and submitted within 14 business days, or an agreed upon extension date,to receive protection under the VAWA. Failure to provide the certification or other supporting documentation within the specified timeframe may result in eviction. Tenant Date Landlord Date Form HUD-91067 (9/2008) CITY OF HUNTINGTON BEACH TENANT BASED RENTAL ASSISTANCE PROGRAM EMERGENCY TRANSFER PLAN Emergency Transfers The City of Huntington Beach ("City") is concerned about the safety of its residents, and such concern extends to residents who are victims of domestic violence, dating violence,sexual assault, or stalking. In accordance with the Violence Against Women Act (VAWA), the City allows residents who are victims of domestic violence,dating violence,sexual assault,or stalking to request an emergency transfer from the resident's current unit to another unit. Despite the name of this law, VAWA protection is available to all victims of domestic violence, dating violence, sexual assault, and stalking, regardless of sex, gender identity,or sexual orientation. The ability to request a transfer is available to all individuals as housing providers cannot discriminate on the basis of any protected characteristic,including race,color,national origin,religion,sex,familial status, disability,or age.United States Department of Housing and Urban Development(HUD)assisted and HUD- insured housing must be made available to all otherwise eligible individuals regardless of actual or perceived sexual orientation, gender identity, or marital status. The ability of the City to honor such request for residents currently receiving assistance, however, may depend upon a preliminary determination that the resident is or has been a victim of domestic violence, dating violence, sexual assault,or stalking,and on whether the City has another dwelling unit that is available and is safe to offer the resident for temporary or more permanent occupancy. This plan identifies residents who are: 1.eligible for an emergency transfer; 2.the documentation needed to request an emergency transfer; 3.confidentiality protections; 4.how an emergency transfer may occur;and 5.guidance to residents on safety and security. The City's plan is based on a model emergency transfer plan published by HUD,the Federal agency that provides funding to the City for its Tenant Based Rental Assistance(TBRA) Program and that oversees that the City is in compliance with VAWA. Eligibility for Emergency Transfers A resident who is a victim of domestic violence,dating violence,sexual assault,or stalking,as provided in HUD's regulations at 24 CFR part 5, subpart L is eligible for an emergency transfer, if: the resident reasonably believes that there is a threat of imminent harm from further violence if the resident remains within the same unit. If the resident is a victim of sexual assault, the resident may also be eligible to transfer if the sexual assault occurred on the premises within the 90-calendar-day period preceding a request for an emergency transfer. • A resident requesting an emergency transfer must expressly request the transfer in accordance with the procedures described in this plan. • Residents who are not in good standing may still request an emergency transfer if they meet the eligibility requirements in this section. According to HUD's regulation 24 CFR part 5,subpart L a victim includes the following: Domestic violence includes felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction receiving grant monies, or by any other person against an adult or youth victim who is protected from that person's'acts under the domestic or family violence laws of the jurisdiction. Dating violence means violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on a consideration of the following factors: The length of the relationship The type of relationship The frequency of interaction between the persons involved in the relationship Sexual assault means any nonconsensual sexual act proscribed by federal, tribal, or state law, including when the victim lacks the capacity to consent. Stalking means to engage in a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others, or suffer substantial emotional distress. Emergency Transfer Request Documentation To request an emergency transfer, the resident shall notify the TBRA case managers and complete a "VAWA Transfer Request"form.The completed form will be received by the TBRA service providers/case managers. The City working with the TBRA service providers/case managers will provide reasonable accommodations to this policy for individuals with disabilities. The resident's written request for an emergency transfer should include either: 1. A statement expressing that the resident reasonably believes that there is a threat of imminent harm from further violence if the resident were to remain in the same dwelling unit assisted under the TBRA's program;OR 2. A statement that the resident was a sexual assault victim and that the sexual assault occurred on the premises during the 90-calendar-day period preceding the residents request for an emergency transfer;AND 3. Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking and alternate documentation form must be completed. (Refer to Form HUD-5382) Confidentiality The TBRA Program service providers will keep confidential any information that the resident submits in requesting an emergency transfer, and information about the emergency transfer, unless the resident gives the TBRA Program service providers written permission to release the information on a time limited basis,or disclosure of the information is required by law or required for use in an eviction proceeding or hearing regarding termination of assistance from the covered program.This includes keeping confidential the new location of the dwelling unit of the tenant,if one is provided,from the person(s)that committed an act(s)of domestic violence,dating violence,sexual assault,or stalking against the resident. NOTE: See the Notice of Occupancy Rights under the Violence Against Women Act For All Tenants for more information about City's and TBRA service providers' responsibility to maintain the confidentiality of information related to incidents of domestic violence, dating violence,sexual assault,or stalking. Emergency Transfer Timing and Availability The City and its TBRA service provider partners cannot guarantee that a transfer request will be approved or how long it will take to process a transfer request.The City and its TBRA service provider partners will, however, act as quickly as possible to move a resident who is a victim of domestic violence, dating violence,sexual assault,or stalking to another unit,subject to availability and safety of a unit. If a resident reasonably believes a proposed transfer would not be safe, the resident may request a transfer to a. different unit. If a unit is available, the transferred resident must agree to abide by the terms and conditions that govern occupancy in the unit to which the resident has been transferred.The City and its TBRA service provider partners cannot transfer a resident to a particular unit if the resident has not or cannot establish eligibility for that unit. If the City and its TBRA service provider partners have no safe and available units for which a resident who needs an emergency is eligible, City and its TBRA service provider partners will identify other housing providers who may have safe and available units to which the resident could move. At the resident's request, City and its TBRA service provider partners will also assist residents in contacting the local organizations offering assistance to victims of domestic violence, dating violence, sexual assault, or stalking. Safety and Security of Residents Pending processing of the transfer and the actual transfer, if it is approved and occurs, the resident is urged to take all reasonable precautions to be safe. National Resources: Residents who are or have been victims of domestic violence are encouraged to contact the National Domestic Violence Hotline at 1-800-799-7233, or a local domestic violence shelter, for assistance in creating a safety plan. For persons with hearing impairments, that hotline can be accessed by calling 1- 800-787-3224(TTY). Residents who have been victims of sexual assault may call the Rape,Abuse& Incest National Network's National Sexual Assault Hotline at 800-656-HOPE,or visit the online hotline at https://www.rainn.ore/ Residents who are or have been victims of stalking seeking help may visit the National Center for Victims of Crime's Stalking Resource Center at https://www.victimsofcrime.org/ourprograms/stalking-resource- center • Exhibit B i Documentation, Recordkeeping, Reporting and Monitoring Requirements • Exhibit B Documentation, Recordkeeping, Reporting and Monitoring Requirements Mercy House(Subrecipient)shall comply with the requirements set forth in this document at all times during the term of the HOME Subrecipient Agreement(Agreement) between the City of Huntington Beach(City)and Subrecipient,to which this document is attached. I. Documentation and Recordkeeping A. Records to be Maintained Subrecipient shall maintain all records required by the federal regulations specified in 24 CFR 92.508(a)(3),which are pertinent to the Services to be funded under the Agreement. Records shall be maintained for each prospective participant,each Eligible Household and each Housing Unit Inspected and/or occupied by an Eligible Household pursuant to the Agreement. Such records shall include but are not limited to: • Records providing a full description of each activity undertaken. • Records required to determine the eligibility of activities for use of HOME funds. a Records(including property inspection reports)demonstrating that each Housing Unit occupied by an Eligible Household meets the property standards of 24 CFR 92.251(d)and 24 CFR 982.401 upon occupancy and at the time of each annual Inspection. • Records demonstrating compliance with the property standards and financial reviews and actions pursuant to 24 CFR§92.504(d). • Records demonstrating that each Eligible Household is income eligible in accordance with 24 CFR 92.203, Including all TBRA applications,eligibility determinations and documentation regarding any appeals of eligibility determinations. • Records demonstrating that Subrecipient is in compliance with the City's written tenant selection policies and criteria of 24 CFR 92.209(c),including any targeting provisions of 24 CFR 92.209(h),and calculation of each Subsidy Payment. • Records demonstrating that each rental agreement for an Eligible Household receiving Subsidy Payments complies with the tenant and participant protections of 24 CFR 92.253. ■ Records documenting compliance with Subrecipients marketing and outreach obligations under the Agreement,including compliance with the fair housing and equal opportunity components of the HOME program and HUD's Affirmative Fair Housing and Marketing regulations and the City's Affirmative Fair Housing Marketing Plan,when adopted. ■ Records documenting compliance with the lead-based hazards requirements under the Agreement, the HOME Program,and 24 CFR Part 35,subparts A,8,J, K,M and R. • Financial records as required by 24 CFR§92.508(a)(5)and 24 CFR§92.222. • Records documenting the HOME Matching Contributions made by Subreciplent pursuant to the Agreement and the HOME Program,specifically including 24 CFR 92.218 through 24 CFR 92.222. B. Retention The Subrecipient shall retain all financial records,supporting documents,statistical records,and all other records pertinent to the Agreement for a period of five years after the period of Subsidy Payments terminates. Notwithstanding the above,if there are litigation matters,claims,audits,negotiations or other actions that involve any of the records cited and that have started before the expiration of the five-year period,then all pertinent records must be retained until completion of the actions and resolution of all issues,or the expiration of the five-year period,whichever occurs later. C. Client Data The Subrecipient shall maintain client data demonstrating client eligibility for services provided. Such data shall include, but not be limited to,client name,address,income level or other basis for determining eligibility,and description of service provided. Such Information shall be made available to City monitors or their designees for review upon request. D. Disclosure The Subrecipient understands that client information collected under this Agreement is private and the • • use or disclosure of such information,when not directly connected with the administration of the City's or Subrecipient's responsibilities with respect to Services provided under this Agreement,is prohibited unless written consent is obtained from such person receiving services and,In case of a minor,that of a responsible parent/guardian. E. Close Outs The Subrecipient's obligation to the City shall not end until all close-out requirements are completed. Activities during the close-out period shall include,but are not limited to: making final payments, disposing of program assets(including the return of all unused materials,equipment,unspent cash advances,program income balances,and accounts receivable to the City),and determining the custodianship of records. Notwithstanding the foregoing,the terms of this Agreement shall remain in effect during any period that the Subrecipient has control over HOME funds,including program income. F. Audits and inspections All Subrecipient records with respect to any matters covered by this Agreement shall be made available to the City, HUD and the Comptroller General of the United States or any of their authorized representatives,at any time during normal business hours,as often as deemed necessary,to audit, examine,and make excerpts or transcripts of all relevant data. Any deficiencies noted in audit reports must be fully cleared by the Subrecipient within 30 days after receipt by the Subrecipient. Failure of the Subrecipient to comply with the above audit requirements will constitute a violation of the Agreement and may result In the withholding of future payments. The Subrecipient hereby agrees to have an annual agency audit conducted in accordance with current City policy concerning Subrecipient audits and OMB Circular A 122. IL Monthly Progress Reports Subreciplent shall submit Monthly progress reports to the City in a form approved or directed by the City,which shall include all of the following information regarding Subrecipient's activities during the prior quarter: • The number of TBRA applications received, processed,approved and disapproved. • The number of Housing Units Inspected,approved and disapproved and a description of any corrective work performed by Landlords to comply with HQS. ■ The number of Eligible Households assisted,Including specific Information regarding the number of and ages of all household members,Income categories,types and amounts of assistance provided to each Eligible Household,and remaining terms of assistance expected to be provided to such households. ■ Description of each Eligible Household's participation in required self-sufficiency program and other optional social and supportive Services provided or otherwise made available to each Eligible Household. • Budget reconciliation Information, including year-to-date expenditures and remaining balance available for Subsidy Payments in accordance with the Budget and the Agreement. • Number of additional Eligible Households Subrecipient expects to qualify and assist within the following three-month period. • Updated schedule of performance of the Services under the Agreement,including a schedule for qualifying and assisting additional Eligible Households as permitted by the Budget. • Information regarding any complaints receipted from Applicants or Eligible Households and any correspondence received from community members or organizations or other nonprofit organizations regarding the Program or specific activities or individuals Involved in the Program. • ■ Documentation of the HOME Matching Contributions made by Subrecipient pursuant to the Agreement and the HOME Program,specifically including 24 CFR 92,218 through 24 CFR 92.222. III. Performance Monitoring A. Monthly Reports Subrecipient shall provide progress reports on a Monthly basis during the first quarter of the Term of the Agreement in order for the City to review Subrecipient's activities and progress under the Agreement and to ensure that the Program is progressing smoothly. B. City Oversight and Review City will monitor the performance of the Subrecipient against the goals and performance standards set forth In the Agreement. From time to time,City shall be entitled to audit and review Subreciplent's ,performance of the Services in accordance with the terms of the Agreement and compliance with the HOME Program. Substandard performance as determined by the City will constitute noncompliance with the Agreement. If action to correct such substandard performance is not taken by the Subrecipient within a reasonable period of time after being notified by the City,termination procedures will be initiated in accordance with Section 8.3 of the Agreement. • Exhibit C Gross Income Calculation Form Income Calculation Worksheet • Semi-Monthly pay cycles are usually 15 days or longer from the 1st-15th and the 16th-30th/31st • Semi-Monthly salaried wage stubs will often show 86.66 or 86.67 under the"hours"section • Bi-Weekly pay cycles are usually 14 days and begin on the same day of the week and end on the same day of the week from pay cycle to pay cycle • For migrant workers,monthly gross income is coputed by averaging the total gross income received during the previous 12 months and is NOT recalculated until the next annual certification Select Appropriate Income Pay Cycle for Applicant Household Weekly:(52 pay periods annually) Member Name: $ + $ + $ _ $ / 3 = $ Weekly Average $ X 52 pay periods$ - gross annual income Member Name: $ + $ + $ _ $ / 3 = $ Weekly Average $ X 52 pay periods$ gross annual income Bi-Weekly:(26 pay periods annually) Member Name: $ + $ + $ _ $ / 3 = $ Bi-Weekly Average $ X 26 pay periods$ gross annual income Member Name: $ + $ + $ _ $ / 3 = $ Bi-Weekly Average $ X 26 pay periods$ gross annual income Semi-Monthly:(24 pay peroids annually) Member Name:- $ + $ + $ _ $ / 3 = $ Semi-Monthly Avg. $ X 24 pay periods$ gross annual income Member Name: $ + $ + $ _ $ / 3 = $ Semi-Monthly Avg. $ X 24 pay periods$ gross annual income Monthly:(12 pay periods annually) Member Name: $ X 12 pay periods$ gross annual income Member Name: $ X 12 pay periods$ gross annual income Fluctuating:use for seasonal,migrant,agricultural, commissions Member Name: $ gross annual income Member Name: $ gross annual income Total Household Annual Income From All Sources Name AGI months Amount per month 12 $ - 12 $ - 12 $ - 12 $ - 12 $ - 12 $ - ICW Completed By _ ICW Completed Date Data Confirmed By Data Confirmed Date TBRA Rent Calculation Head of Household: First Name, Last name Date: Address: Street address Household Size: 2 Unit Size: Studio, 1BR,2BR,etc Source(s)of income: Annual gross income: 1) _ $ 2) _ $ 3) _ $ 4) _ $ TOTAL ANNUAL GROSS INCOME: $ 0.00 Less: Dependent Allowance(Table C) 0.00 TOTAL ADJUSTED AGI: 0.00 Monthly Income: $ 0.00 [ultiply by 300/0: 0.00 Resident deposit share: 0.00 Minus Utility Allowance(Table D): 0.00 Resident rent share per calculation: 0.00 Contract Rent(Lease Agreement): Resident rent share per CM review: Case Manager Notes: Resident(sign) Date Resident(print) Date Resident(sign) Date Resident(print) Date Families Forward Staff Date (Table B: Maximum Household income (for all units) Based on 80%AMI as established by HUD dated: 4/1/2024 30% 50% 60% 80% 1 person 33,150 55,250 66,300 88,400 2 person 37,900 63,100 75,720 101,000 3 person 42,650 71,050 85,260 113,650 4 person 47,350 78,900 94,680 126,250 5 person 51,150 85,250 102,300 136,350 6 person 54,950 91,550 109,860 146,450 7 person 58,750 97,850 117,420 156,550 8 person 62,550 104,150 124,980 166,650 Table C: Dependent Allowance .IMM $480 for each dependent $400 for each elderly or disabled family 1 dependent 480 1 elderly/disabled 400 2 dependent 960 2 elderly/disabled 800 3 dependent 1,440 3 elderly/disabled 1,200 4 dependent 1,920 4 elderly/disabled 1,600 5 dependent 2,400 5 elderly/disabled 2,000 6 dependent 2,880 6 elderly/disabled 2,400 7 dependent 3,360 7 elderly/disabled 2,800 Total: Total: Table D: Utili Allowance ,• :� Utility Allowance must be deducted if resident pays own utilities. Based on Orange County Housing Authority figures dated: 10/1/2023 1 bedroom: Gas Cooking: $4.00 2 bedroom: Gas Cooking: $7.00 Gas Heating: $18.00 Gas Heating: $21.00 Gas Water Heater: $10.00 Gas Water Heater: $14.00 Basic Electric: $35.00 Basic Electric: $49.00 Electric Cooking: $11.00 Electric Cooking: $17.00 Electric Heating: $22.00 Electric Heating: $25.00 Electric Water Heater: $30.00 Electric Water Heater: $38.00 Water: $49.00 Water: $71.00 Trash&Sewer: $30.00 Trash&Sewer: $30.00 Total: Total: 3 bedroom: Gas Cooking: $9.00 4 bedroom: Gas Cooking: $12.00 Gas Heating: $22.00 Gas Heating: $25.00 Gas Water Heater: $20.00 Gas Water Heater: $26.00 Basic Electric: $65.00 Basic Electric: $82.00 Electric Cooking: $21.00 Electric Cooking: $27.00 Electric Heating: $28.00 Electric Heating: $30.00 Electric Water Heater: $46.00 Electric Water Heater: $55.00 Water: $104.00 Water: $138.00 Trash&Sewer: $30.00 Trash&Sewer: $30.00 Total: Total: 5.5.1 Definition of Adjusted Income Adjusted income is annual (gross) income reduced by deductions for dependents, elderly households, medical expenses, handicap assistance expenses and childcare (these are the same adjustment factors used by the Section 8 Program). Adjusted income is used to calculate the tenant contribution or payment in the TBRA program. Mandatory deductions are found in 24 CFR 5.611. • $480 for each dependent; • $400 for any elderly family or disabled family; • Unreimbursed medical expenses, to the extent the sum exceeds 3% of annual income • Disability assistance deduction; and Page 12 of 23 • Any reasonable child care expenses necessary to enable a member of the family to be employed or to further his or her education. 24 CFR 5.611 Exhibit D Household Budget Worksheet Housing Budget Date: Name: Summary Percentage of Income Spent TOTAL MONTHLY INCOME so TOTAL MONTHLY EXPENSES 0 so % TOTAL MONTHLY SAVINGS CASH BALANCE Checking Account Balance: $0 I Monthly Income Monthly Expenses ITEM AMOUNT ITEM AMOUNT Earned riel Rent Cashaid fiR7-- Home Insurance CalFresh utilities / Gas Monthly Savings = Cell phone ITEM AMOUNT Internet/Cable Monthly Savings 01 Groceries Outstanding Debts Car Payment ITEM AMOUNT Transportation Credit Card ral Student Loans Personal Loan 1 Personal Loan Flute` Child Care Other:Rent _a) Auto Insurance 4 JI Personal Care 0 Internet/Cable Earned Income vs. Expenses Si $1 $1 $1 Si $1 $o so $o so so ■Income ■ Expenses Client Signature Date Case Manager Signature Date Exhibit E Lead-Based Hazard Information Pamphlet "Protect Your Family from Lead in your Home" gr Protect �- �` Your ,.._44, •� Family .„,.., From . _ Lead in IP* AK °1: ....j1 Your Home _ ... . /.., A United Ill.�C��:1'• IIIIIIII \ EPA EnvironmentalStates 1 Protection Agency United States �—l`ifir Consumer Product -- Safety Commission J- _ � I I �� y PZMENTpF United States ioixillirligru---- ( tHflI) and Urban Development 96gN DEV EEO March 2021 Are You Planning to Buy or Rent a Home Built Before 1978? Did you know that many homes built before 1978 have lead-based paint? Lead from paint,chips,and dust can pose serious health hazards. Read this entire brochure to learn: • How lead gets into the body • How lead affects health • What you can do to protect your family • Where to go for more information Before renting or buying a pre-1978 home or apartment,federal law requires: • Sellers must disclose known information on lead-based paint or lead- based paint hazards before selling a house. • Real estate sales contracts must include a specific warning statement about lead-based paint. Buyers have up to 10 days to check for lead. • Landlords must disclose known information on lead-based paint or lead-based paint hazards before leases take effect. Leases must include a specific warning statement about lead-based paint. If undertaking renovations, repairs,or painting (RRP) projects in your pre-1978 home or apartment: • Read EPA's pamphlet,The Lead-Safe Certified Guide to Renovate Right, to learn about the lead-safe work practices that contractors are required to follow when working in your home(see page 12). AMMO0 i . AEI AIM e,, Simple Steps to Protect Your Family from Lead Hazards If you think your home has lead-based paint: • Don't try to remove lead-based paint yourself. • Always keep painted surfaces in good condition to minimize deterioration. • Get your home checked for lead hazards.Find a certified inspector or risk assessor at epa.gov/lead. • Talk to your landlord about fixing surfaces with peeling or chipping paint. • Regularly clean floors,window sills,and other surfaces. • Take precautions to avoid exposure to lead dust when remodeling. • When renovating,repairing,or painting, hire only EPA-or state- approved Lead-Safe certified renovation firms. • Before buying, renting,or renovating your home, have it checked for lead-based paint. • Consult your health care provider about testing your children for lead.Your pediatrician can check for lead with a simple blood test. • Wash children's hands, bottles,pacifiers,and toys often. • Make sure children eat healthy, low-fat foods high in iron, calcium,and vitamin C. • Remove shoes or wipe soil off shoes before entering your house. 1 Lead Gets into the Body in Many Ways Adults and children can get lead into their bodies if they: • Breathe in lead dust(especially during activities such as renovations, repairs,or painting that disturb painted surfaces). • Swallow lead dust that has settled on food,food preparation surfaces, and other places. • Eat paint chips or soil that contains lead. Lead is especially dangerous to children under the age of 6. • At this age,children's brains and nervous systems are more sensitive to the damaging effects of lead. 49. • Children's growing bodies absorb more lead. • Babies and young children often put their hands - . and other objects in their -^� , mouths.These objects can �� - have lead dust on them. Women of childbearing age should know that lead is dangerous to a developing fetus. • Women with a high lead level in their system before or during pregnancy risk exposing the fetus to lead through the placenta during fetal development. 2 Health Effects of Lead Lead affects the body in many ways. It is important to know that even exposure to low levels of lead can severely harm children. In children,exposure to lead can cause: Brain Nerve Damage Hearing • Nervous system and kidney damage Problems • Learning disabilities,attention-deficit disorder,and decreased intelligence Slowed Growt • Speech, language,and behavior problems • Poor muscle coordination • Decreased muscle and bone growth • Hearing damage De Problems ^ Problems / ` While low-lead exposure is most common, Reproductive Problems exposure to high amounts of lead can have (Adults) devastating effects on children,including seizures,unconsciousness,and in some cases,death. Although children are especially susceptible to lead exposure, lead can be dangerous for adults,too. In adults,exposure to lead can cause: • Harm to a developing fetus • Increased chance of high blood pressure during pregnancy • Fertility problems(in men and women) • High blood pressure • Digestive problems • Nerve disorders • Memory and concentration problems • Muscle and joint pain 3 Check Your Family for Lead Get your children and home tested if you think your home has lead. Children's blood lead levels tend to increase rapidly from 6 to 12 months of age,and tend to peak at 18 to 24 months of age. Consult your doctor for advice on testing your children.A simple blood test can detect lead. Blood lead tests are usually recommended for: • Children at ages 1 and 2 • Children or other family members who have been exposed to high levels of lead • Children who should be tested under your state or local health screening plan Your doctor can explain what the test results mean and if more testing will be needed. 4 Where Lead-Based Paint Is Found In general,the older your home or childcare facility,the more likely it has lead-based paint.' Many homes,including private,federally-assisted,federally- owned housing,and childcare facilities built before 1978 have lead-based paint.In 1978,the federal government banned consumer uses of lead-containing paint.' Learn how to determine if paint is lead-based paint on page 7. Lead can be found: • In homes and childcare facilities in the city,country,or suburbs, • In private and public single-family homes and apartments, • On surfaces inside and outside of the house,and • In soil around a home.(Soil can pick up lead from exterior paint or other sources,such as past use of leaded gas in cars.) Learn more about where lead is found at epa.gov/lead. 1 "Lead-based paint"is currently defined by the federal government as paint with lead levels greater than or equal to 1.0 milligram per square centimeter(mg/cm2),or more than 0.5%by weight. 2 "Lead-containing paint"is currently defined by the federal government as lead in new dried paint in excess of 90 parts per million(ppm)by weight. 5 Identifying Lead-Based Paint and Lead-Based Paint Hazards Deteriorated lead-based paint(peeling,chipping,chalking, cracking,or damaged paint)is a hazard and needs immediate attention. Lead-based paint may also be a hazard when found on surfaces that children can chew or that get a lot of wear and tear, such as: • On windows and window sills • Doors and door frames • Stairs, railings, banisters,and porches Lead-based paint is usually not a hazard if it is in good condition and if it is not on an impact or friction surface like a window. Lead dust can form when lead-based paint is scraped,sanded,or heated. Lead dust also forms when painted surfaces containing lead bump or rub together.Lead paint chips and dust can get on surfaces and objects that people touch.Settled lead dust can reenter the air when the home is vacuumed or swept,or when people walk through it. EPA currently defines the following levels of lead in dust as hazardous: • 10 micrograms per square foot(µg/ft2) and higher for floors, including carpeted floors • 100 µg/ft2 and higher for interior window sills Lead in soil can be a hazard when children play in bare soil or when people bring soil into the house on their shoes.EPA currently defines the following levels of lead in soil as hazardous: • 400 parts per million (ppm)and higher in play areas of bare soil • 1,200 ppm (average) and higher in bare soil in the remainder of the yard Remember,lead from paint chips—which you can see—and lead dust—which you may not be able to see—both can be hazards. The only way to find out if paint,dust,or soil lead hazards exist is to test for them.The next page describes how to do this. 6 Checking Your Home for Lead You can get your home tested for lead in several different ways: • A lead-based paint inspection tells you if your home has lead- based paint and where it is located. It won't tell you whether your home currently has lead hazards.A trained and certified testing professional,called a lead-based paint inspector,will conduct a paint inspection using methods,such as: • Portable x-ray fluorescence(XRF) machine • Lab tests of paint samples • A risk assessment tells you if your home currently has any lead hazards from lead in paint,dust,or soil.It also tells you what actions to take to address any hazards.A trained and certified testing professional, called a risk assessor,will: • Sample paint that is deteriorated on doors,windows,floors,stairs, and walls • Sample dust near painted surfaces and sample bare soil in the yard • Get lab tests of paint,dust,and soil samples • A combination inspection and risk assessment tells you if your home has any lead-based paint and if your home has any lead hazards,and where both are located. Be sure to read the report provided to you after your inspection or risk assessment is completed,and ask questions about anything you do not understand. 7 Checking Your Home for Lead, continued In preparing for renovation,repair,or painting work in a pre-1978 home, Lead-Safe Certified renovators(see page 12) may: • Take paint chip samples to determine if lead-based paint is present in the area planned for renovation and send them to an EPA-recognized lead lab for analysis. In housing receiving federal assistance,the person collecting these samples must be a certified lead-based paint inspector or risk assessor • Use EPA-recognized tests kits to determine if lead-based paint is absent(but not in housing receiving federal assistance) • Presume that lead-based paint is present and use lead-safe work practices There are state and federal programs in place to ensure that testing is done safely, reliably,and effectively.Contact your state or local agency for more information,visit epa.gov/lead,or call 1-800-424-LEAD (5323)for a list of contacts in your area.3 3 Hearing-or speech-challenged individuals may access this number through TTY by calling the Federal Relay Service at 1-800-877-8339. 8 What You Can Do Now to Protect Your Family If you suspect that your house has lead-based paint hazards,you can take some immediate steps to reduce your family's risk: • If you rent, notify your landlord of peeling or chipping paint. • Keep painted surfaces clean and free of dust.Clean floors,window frames,window sills,and other surfaces weekly. Use a mop or sponge with warm water and a general all-purpose cleaner.(Remember: never mix ammonia and bleach products together because they can form a dangerous gas.) • Carefully clean up paint chips immediately without creating dust. • Thoroughly rinse sponges and mop heads often during cleaning of dirty or dusty areas,and again afterward. • Wash your hands and your children's hands often,especially before they eat and before nap time and bed time. • Keep play areas clean.Wash bottles, pacifiers,toys,and stuffed animals regularly. • Keep children from chewing window sills or other painted surfaces,or eating soil. • When renovating,repairing,or painting, hire only EPA-or state- approved Lead-Safe Certified renovation firms(see page 12). • Clean or remove shoes before entering your home to avoid tracking in lead from soil. • Make sure children eat nutritious, low-fat meals high in iron,and calcium,such as spinach and dairy products.Children with good diets absorb less lead. 9 Reducing Lead Hazards Disturbing lead-based paint or ( [ removing lead improperly can increase the hazard to your family by spreading even more lead dust around flT 1' the house. I • In addition to day-to-day cleaning and good nutrition,you can temporarily reduce lead-based paint } r`< • .,, hazards by taking actions,such as repairing damaged painted surfaces I t and planting grass to cover lead- l ;1 I I contaminated soil.These actions are not permanent solutions and will need ongoing attention. • You can minimize exposure to lead when renovating,repairing,or painting by hiring an EPA-or state- certified renovator who is trained in the use of lead-safe work practices. If you are a do-it-yourselfer, learn how to use lead-safe work practices in your home. • To remove lead hazards permanently,you should hire a certified lead abatement contractor.Abatement(or permanent hazard elimination) methods include removing,sealing,or enclosing lead-based paint with special materials.Just painting over the hazard with regular paint is not permanent control. Always use a certified contractor who is trained to address lead hazards safely. • Hire a Lead-Safe Certified firm (see page 12)to perform renovation, repair,or painting (RRP) projects that disturb painted surfaces. • To correct lead hazards permanently, hire a certified lead abatement contractor.This will ensure your contractor knows how to work safely • and has the proper equipment to clean up thoroughly. Certified contractors will employ qualified workers and follow strict safety rules as set by their state or by the federal government. 10 Reducing Lead Hazards, continued If your home has had lead abatement work done or if the housing is receiving federal assistance,once the work is completed,dust cleanup activities must be conducted until clearance testing indicates that lead dust levels are below the following levels: • 10 micrograms per square foot(pg/ft2) for floors, including carpeted floors • 100 pg/ft2 for interior windows sills • 400 pg/ft2 for window troughs Abatements are designed to permanently eliminate lead-based paint hazards.However, lead dust can be reintroduced into an abated area. • Use a HEPA vacuum on all furniture and other items returned to the area,to reduce the potential for reintroducing lead dust. • Regularly clean floors,window sills,troughs,and other hard surfaces with a damp cloth or sponge and a general all-purpose cleaner. Please see page 9 for more information on steps you can take to protect your home after the abatement. For help in locating certified lead abatement professionals in your area,call your state or local agency(see pages 15 and 16),epa.gov/lead,or call 1-800-424-LEAD. 11 Renovating, Repairing or Painting a Home with Lead-Based Paint If you hire a contractor to conduct renovation,repair,or painting (RRP) projects in your pre-1978 home or childcare facility(such as pre-school and kindergarten),your contractor must: • Be a Lead-Safe Certified firm approved by EPA or an 1•i:!,:rY7'•1»y�rrlil31�11rETD EPA-authorized state program 11'� �r E • Use qualified trained individuals (Lead-Safe 1),J c" Certified renovators) who follow specific lead-safe work practices to prevent lead contamination • • Provide a copy of EPA's lead hazard information document,The Lead-Safe Certified Guide to ; Renovate Right RRP contractors working in pre-1978 homes and childcare facilities must follow lead-safe work practices that: • Contain the work area.The area must be contained so that dust and debris do not escape from the work area.Warning signs must be put up,and plastic or other impermeable material and tape must be used. • Avoid renovation methods that generate large amounts of lead-contaminated dust.Some methods generate so much lead- contaminated dust that their use is prohibited.They are: • Open-flame burning or torching • Sanding,grinding,planing, needle gunning,or blasting with power tools and equipment not equipped with a shroud and HEPA vacuum attachment • Using a heat gun at temperatures greater than 1100°F • Clean up thoroughly.The work area should be cleaned up daily. When all the work is done,the area must be cleaned up using special cleaning methods. • Dispose of waste properly.Collect and seal waste in a heavy duty bag or sheeting.When transported,ensure that waste is contained to prevent release of dust and debris. To learn more about EPA's requirements for RRP projects,visit epa.gov/getleadsafe,or read The Lead-Safe Certified Guide to 12 Renovate Right. Other Sources of Lead Lead in Drinking Water The most common sources of lead in drinking water are lead pipes, faucets,and fixtures. Lead pipes are more likely to be found in older cities and homes built before 1986. You can't smell or taste lead in drinking water. To find out for certain if you have lead in drinking water, have your water tested. Remember older homes with a private well can also have plumbing materials that contain lead. Important Steps You Can Take to Reduce Lead in Drinking Water • Use only cold water for drinking,cooking and making baby formula. Remember,boiling water does not remove lead from water. • Before drinking,flush your home's pipes by running the tap,taking a shower,doing laundry,or doing a load of dishes. • Regularly clean your faucet's screen (also known as an aerator). • If you use a filter certified to remove lead,don't forget to read the directions to learn when to change the cartridge.Using a filter after it has expired can make it less effective at removing lead. Contact your water company to determine if the pipe that connects your home to the water main (called a service line) is made from lead. Your area's water company can also provide information about the lead levels in your system's drinking water. For more information about lead in drinking water, please contact EPA's Safe Drinking Water Hotline at 1-800-426-4791. If you have other questions about lead poisoning prevention,call 1-800424-LEAD.* Call your local health department or water company to find out about testing your water,or visit epa.gov/safewater for EPA's lead in drinking water information.Some states or utilities offer programs to pay for water testing for residents.Contact your state or local water company to learn more. *Hearing-or speech-challenged individuals may access this number through TTY 13 by calling the Federal Relay Service at 1-800-877-8339. Other Sources of Lead, continued • Lead smelters or other industries that release lead into the air. • Your job.If you work with lead,you could bring it home on your body or clothes.Shower and change clothes before coming home. Launder your work clothes separately from the rest of your family's clothes. • Hobbies that use lead,such as making pottery or stained glass, or refinishing furniture.Call your local health department for information about hobbies that may use lead. • Old toys and furniture may have been painted with lead-containing paint.Older toys and other children's products may have parts that contain lead 4 • Food and liquids cooked or stored in lead crystal or lead-glazed pottery or porcelain may contain lead. • Folk remedies,such as"greta"and"azarcon,"used to treat an upset stomach. • In 1978,the federal government banned toys,other children's products,and furniture with lead-containing paint.In 2008,the federal government banned lead in most children's products.The federal government currently bans lead in excess of 100 ppm by weight in most children's products. 14 For More Information The National Lead Information Center Learn how to protect children from lead poisoning and get other information about lead hazards on the Web at epa.gov/lead and hud.gov/lead,or call 1-800-424-LEAD(5323). EPA's Safe Drinking Water Hotline For information about lead in drinking water,call 1-800-426-4791,or visit epa.gov/safewater for information about lead in drinking water. Consumer Product Safety Commission (CPSC) Hotline For information on lead in toys and other consumer products,or to report an unsafe consumer product or a product-related injury,call 1-800-638-2772,or visit CPSC's website at cpsc.gov or saferproducts.gov. State and Local Health and Environmental Agencies Some states,tribes,and cities have their own rules related to lead- based paint.Check with your local agency to see which laws apply to you.Most agencies can also provide information on finding a lead abatement firm in your area,and on possible sources of financial aid for reducing lead hazards.Receive up-to-date address and phone information for your state or local contacts on the Web at epa.gov/lead, or contact the National Lead Information Center at 1-800-424-LEAD. Hearing-or speech-challenged individuals may access any of the phone numbers in this brochure through TTY by calling the toll- free Federal Relay Service at 1-800-877-8339. 15 U. S. Environmental Protection Agency (EPA) Regional Offices The mission of EPA is to protect human health and the environment. Your Regional EPA Office can provide further information regarding regulations and lead protection programs. Region 1(Connecticut,Massachusetts,Maine, Region 6(Arkansas,Louisiana,New Mexico, New Hampshire,Rhode Island,Vermont) Oklahoma,Texas,and 66 Tribes) Regional Lead Contact Regional Lead Contact U.S.EPA Region 1 U.S.EPA Region 6 5 Post Office Square,Suite 100,OES 05-4 1445 Ross Avenue,12th Floor Boston,MA 02109-3912 Dallas,TX 75202-2733 (888)372-7341 (214)665-2704 Region 2(New Jersey,New York,Puerto Rico, Region 7(Iowa,Kansas,Missouri,Nebraska) Virgin Islands) Regional Lead Contact Regional Lead Contact U.S.EPA Region 7 U.S.EPA Region 2 11201 Renner Blvd. 2890 Woodbridge Avenue Lenexa,KS 66219 Building 205,Mail Stop 225 (800)223-0425 Edison,NJ 08837-3679 (732)906-6809 Region 8(Colorado,Montana,North Dakota,South Dakota,Utah,Wyoming) Region 3(Delaware,Maryland,Pennsylvania, Regional Lead Contact Virginia,DC,West Virginia) U.S.EPA Region 8 Regional Lead Contact 1595 Wynkoop St. U.S.EPA Region 3 Denver,CO 80202 1650 Arch Street (303)312-6966 Philadelphia,PA 19103 (215)814-2088 Region 9(Arizona,California,Hawaii, Nevada) Region 4(Alabama,Florida,Georgia, Regional Lead Contact Kentucky,Mississippi,North Carolina,South U.S.EPA Region 9(CMD 4 2) Carolina,Tennessee) 75 Hawthorne Street Regional Lead Contact San Francisco,CA 94105 U.S.EPA Region 4 (415)947-4280 AFC Tower,12th Floor,Air,Pesticides&Toxics 61 Forsyth Street,SW Region 10(Alaska,Idaho,Oregon, Atlanta,GA 30303 Washington) (404)562-8998 Regional Lead Contact Region 5(Illinois,Indiana,Michigan, U.S.EPA Region 10(20-004) Air and Toxics Enforcement Section Minnesota,Ohio,Wisconsin) 1200 Sixth Avenue,Suite 155 Regional Lead Contact Seattle,WA 98101 U.S.EPA Region 5(LL-17J) (206)553-1200 77 West Jackson Boulevard Chicago,IL 60604-3666 (312)353-3808 16 Consumer Product Safety Commission (CPSC) The CPSC protects the public against unreasonable risk of injury from consumer products through education, safety standards activities, and enforcement. Contact CPSC for further information regarding consumer product safety and regulations. CPSC 4330 East West Highway Bethesda, MD 20814-4421 1-800-638-2772 cpsc.gov or saferproducts.gov U. S. Department of Housing and Urban Development (HUD) HUD's mission is to create strong, sustainable, inclusive communities and quality affordable homes for all. Contact to Office of Lead Hazard Control and Healthy Homes for further information regarding the Lead Safe Housing Rule,which protects families in pre-1978 assisted housing, and for the lead hazard control and research grant programs. HUD 451 Seventh Street, SW, Room 8236 Washington, DC 20410-3000 (202) 402-7698 hud.gov/lead This document is in the public domain.It may be produced by an individual or organization without permission.Information provided in this booklet is based upon current scientific and technical understanding of the issues presented and is reflective of the jurisdictional boundaries established by the statutes governing the co-authoring agencies.Following the advice given will not necessarily provide complete protection in all situations or against all health hazards that can be caused by lead exposure. U.S.EPA Washington DC 20460 EPA-747-K-12-001 U.S.CPSC Bethesda MD 20814 March 2021 U.S.HUD Washington DC 20410 17 IMPORTANT! Lead From Paint, Dust, and Soil in and Around Your Home Can Be Dangerous if Not Managed Properly • Children under 6 years old are most at risk for lead poisoning in your home. • Lead exposure can harm young children and babies even before they are born. • Homes, schools, and child care facilities built before 1978 are likely to contain lead-based paint. • Even children who seem healthy may have dangerous levels of lead in their bodies. • Disturbing surfaces with lead-based paint or removing lead-based paint improperly can increase the danger to your family. • People can get lead into their bodies by breathing or swallowing lead dust, or by eating soil or paint chips containing lead. • People have many options for reducing lead hazards. Generally, lead-based paint that is in good condition is not a hazard (see page 10). FAMIFOR-01 LBOSSHART ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/12/2024 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 endorsement(s). PRODUCER License#0M10410 CONTACT NAME: Armstrong)/Robitaille/Riegle Business and Insurance Solutions PHONE H NNo,Ext):(949)381-7700 jAc,No);(949)861-9429 Newport Beach,CA 92660 b 1 SS;arrinfo@aleragroup.com I INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Nonprofits Insurance Alliance Group 10023 INSURED INSURER B:Service American Indemnity Company 39152 Families Forward INSURERC: 8 Thomas INSURER D: Irvine,CA 92618 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POUCY EFF POUCY EXP LIMITS LTR INSD WVD (MM/DD/YYYY1 (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 2024-02647 7/1/2024 7/1/2025 DAMAGETORENTED 500,000 X X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY YP8f X LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: LIQUOR LIAB $ 1,000,000 A AUTOMOBILE LUIBIUTY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) X ANY AUTO 2024-02647 7/1/2024 7/1/2025 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRE� ONLY AUTOS SSWt)Ep BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONLY ((Peer acddent)AMAGE A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS UAB CLAIMS-MADE 2024-02647-UMB 7/1/2024 7/1/2025 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N X SAT150579600 7/1/2024 7/1/2025 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE,] 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liab 2024-02647 7/1/2024 7/1/2025 Each Occurrence 1,000,000 A Professional Liab 2024-02647 7/1/2024 7/1/2025 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) The City of Huntington Beach,its officers,elected or appointed officials,employees,agents and volunteers are named as additional insu on th eneral Liability per attached form,as required by written contract.Primary and Non-Contributory applies to the General LiMscovagic MICHAELE CITY ATT EY CF'i Y Of HUN, ON BEACH CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Cityof Huntington Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ursula Luna-Reynosa 2000 Main Street Huntington Beach,CA 92648 AUTHORIZED REPRESENTATIVE A444. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PROFITS i- NON ❑ INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance.A Heart for Nonprofits. POLICY NUMBER: 2024-02647 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: A. Section II —WHO IS AN INSURED is amended to include: 4.Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s)on your policy, but only with respect to liability for"bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your negligent acts or omissions; or b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. B. Section III—LIMITS OF INSURANCE is amended to include: 8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or NIAC-E61 02 19 Page 1 of 2 NONPROFITS 11"1 INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance.A Heart for Nonprofits. POLICY NUMBER: 2024-02647 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1)and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance,whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for"property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos"or watercraft to the extent not subject to Exclusion g. of SECTION I—COVERAGE A— BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s)against any"suit" if any other insurer has a duty to defend the additional insured(s)against that"suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s)does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 02 19 Page 2 of 2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you per- form work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0 . 020 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Blanket waiver of subrogation as required by written Job Description contract . This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Date:0 7/01/2 0 2 4 Policy No. SATI S 0 5 7 9 6 0 0 Endorsement No. Policy Effective Date: 07/01/2024 to 07/01/2025 Premium $ Insured: Families Forward DBA: Carrier Name/Code: Service American Indemnity Company Countersigned by WC040306 (Ed.4-84) Page 1 of 1