proposal cover sheet - harris county, texas doc/pj199877biddoc.pdf · request for proposal cover...

HARRIS COUNTY REQUEST FOR PROPOSAL

COVER SHEET

PROPOSAL FOR: Community Development Block Grant – Disaster Recovery Affordable Rental Housing Program for the Harris County Community Services Department (Estimated to begin January 1, 2019 and ending June 1, 2022)

DUE DATE: Friday, March 1, 2019

Due no later than 2:00 P.M. local time in Houston, Texas. Proposals received later than the date and time above will not be considered.

OFFERORS NOTE: Carefully read all instructions, requirements and specifications. Fill out all forms properly

and completely. Submit your proposal with all appropriate supplements and/or samples in an appropriately sized envelope or box. PACKAGE MUST SHOW THE JOB NUMBER, DESCRIPTION AND BE MARKED “SEALED PROPOSAL”.

RETURN PROPOSAL TO: HARRIS COUNTY COMMUNITY SERVICES DEPARTMENT 8410 LANTERN POINT DRIVE HOUSTON, TEXAS 77054 Contact: Candace Stevens at [email protected] or 832-927-4802 Priority 1 Priority 2 Priority 3 Total Amount of Proposal: $

Company Name: Company Address: City, State, Zip Code: Taxpayer Identification Number (T.I.N.): Telephone: Fax: e-mail: Do you carry Health Insurance on your employees? Yes ___ No If yes, what % of employees: _ __% Print Name: Signature: Vendor must sign in INK; failure to sign WILL disqualify the offer. All prices must be typewritten or written in ink. Revised 09/14

GENERAL REQUIREMENTS FOR PROPOSALS

READ THIS ENTIRE DOCUMENT CAREFULLY. FOLLOW ALL INSTRUCTIONS. YOU ARE RESPONSIBLE FOR FULFILLING ALL REQUIREMENTS AND SPECIFICATIONS. BE SURE YOU UNDERSTAND THEM. General Requirements apply to all advertised requests for proposals; however, these may be superseded, whole or in part, by OTHER DATA CONTAINED HEREIN. Review the Table of Contents. Be sure your proposal package is complete. ACCESS TO RECORDS In special circumstances, vendor may be required to allow duly authorized representatives of Harris County, the Harris County Hospital District or the state and federal government access to contracts, books, documents, and records necessary to verify the nature and extent of the cost of services provided by vendor. Vendor must keep records within Harris County or note in proposal that records will be available within the boundaries of Harris County to those representatives within twenty-four (24) hours of request by the County. ACH VENDOR PAYMENT (Automated Clearinghouse) Harris County offers ACH vendor payment services for all vendors providing products or services. Instructions and authorization agreement forms are provided at www.hctx.net/auditor/. ADDENDA When specifications are revised, the Harris County Purchasing Department will issue an addendum addressing the nature of the change. Offerors must sign and include it in the returned proposal package. ASSIGNMENT The successful offeror may not assign, sell or otherwise transfer this contract without written permission of Harris County Commissioners Court or other applicable governing body. AWARD Harris County reserves the right to award this contract on the basis of LOWEST AND BEST OFFER in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one offeror, to reject any or all proposals. In the event the lowest dollar offeror meeting specifications is not awarded a contract, the offeror may appear before the Commissioners Court, Hospital District Board of Trustees, the Juvenile Board or other applicable governing body and present evidence concerning his responsibility after officially notifying the Office of the Purchasing Agent of his intent to appear. BONDS If this RFP requires submission of proposal guarantee and performance and payment bonds, there will be a separate page explaining those requirements. Proposals submitted without the required proposal bond or cashier's checks are not acceptable. CERTIFICATE OF INTERESTED PARTIES (FORM 1295) Texas law requires all parties who enter into any contract with the County which must be approved by Commissioners Court to disclose all interested parties. Form 1295 must be completed in its entirety at the following website: https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm prior to submitting your response. Failure to do so may result in disqualification of your response. CERTIFICATION REGARDING DEBARMENT, SUSPENSION INELIGIBILITY, AND VOLUNTARY EXCLUSION The Contractor certifies by execution of this Contract that it is not ineligible for participation in federal or state assistance programs under Executive Order 12549, "Debarment and Suspension." Additionally, contractor warrants and represents by execution of this Contract that it is not debarred, suspended, or otherwise excluded from or ineligible for participation in any Federal programs, including but not limited to the following: Department of Health and Human Work (DHHS), Office of Inspector General (OIG) - List of Excluded Individuals & Entities (LEIE); U.S. General Work Administration (GSA) – Excluded Parties List System (EPLS); All States (50) Health & Human Work Commission Medicaid OIG Sanction List; Government Terrorist Watch List (OFAC / Patriot Act); Department of Commerce, Bureau of Industry and Security, Denied Persons List; and Department of Homeland Security, Immigration and Customs Enforcement (ICE) Most Wanted. The Contractor further agrees to include this certification in all contracts between itself and any subcontractors in connection with the services performed under this Contract. Contractor also certifies that contractor will notify Harris County in writing immediately if contractor is not in compliance with Executive Order 12549 during the term of this contract. Contractor agrees to refund Harris County for any payments made to the contractor while ineligible. Page 4 of 21

COMPLIANCE WITH FEDERAL, STATE, AND LOCAL LAWS The vendor shall follow all federal, state, and local laws, rules, codes, ordinances, and regulations applicable to the vendor’s Services. Pursuant to Chapter 2252, Texas Government Code, the vendor represents and certifies that, at the time of execution of this Contract/Agreement neither the vendor, nor any wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate of the same (i) engages in business with Iran, Sudan, or any foreign terrorist organization as described in Chapters 806 or 807 of the Texas Government Code, or Subchapter F of Chapter 2252 of the Texas Government Code, or (ii) is a company listed by the Texas Comptroller of Public Accounts under Sections 806.051, 807.051, or 2252.153 of the Texas Government Code. The term "foreign terrorist organization" in this paragraph has the meaning assigned to such term in Section 2252.151 of the Texas Government Code. The vendor warrants and represents that it will pay all its workers all monies earned by its workers including, but not limited to regular wages, any overtime compensation, or any additional payments pursuant to the Fair Labor Standards Act, 29 U.S.C. Section 207 9a(1), as amended; the Texas Pay Day Act; the Equal Pay Act; Title VII of the Civil Rights Act of 1964, 42 U.S.C. Section 2000e, et al., as amended; or any provisions of the Texas Labor Code Ann., as amended. Harris County operates its business ethically and in compliance with the law. We ask that any contractor’s or vendor’s employee doing business with Harris County who believes he or she has witnessed any suspected ethical violation or fraud immediately report the allegations to: Harris County Purchasing Agent, 1001 Preston, Suite 670, Houston, Texas 77002, 713-274-4400, [email protected] Harris County will conduct a prompt and thorough investigation. At the conclusion of the investigation, Harris County will refer any suspected criminal activity to the District Attorney or an appropriate law enforcement agency. Contractors or vendors who report suspected ethical violations or fraud can do so without fear of retaliation. Retaliating against any contractor or vendor for reporting suspected ethical violations or fraud is strictly prohibited. In accordance with Tex. Gov’t Code Ann. § 2270.002, Contractor/Vendor warrants and represents that it does not boycott Israel and agrees that it will not boycott Israel during the term of this contract. CONTRACT OBLIGATION Harris County Commissioners Court must award the contract and the County Judge or other person authorized by the Harris County Commissioners Court must sign the contract before it becomes binding on Harris County or the offerors. Department heads are NOT authorized to sign agreements for Harris County. Binding agreements shall remain in effect until all products and/or services covered by this purchase have been satisfactorily delivered and accepted. CONTRACT RENEWALS Renewals may be made ONLY by written agreement between Harris County and the offeror. Any price escalations are limited to those stated by the offeror in the original proposal. CONTRACT TRANSITION In the event services end by either contract expiration or termination, it shall be required that the vendor continue services if requested by Harris County Purchasing, until new services can be completely operational. The vendor acknowledges its responsibility to cooperate fully with the replacement vendor and Harris County to ensure a smooth and timely transition to the replacement vendor. Such transitional period shall not extend more than ninety (90) days beyond the expiration/termination date of the contract, or any extension thereof. The vendor shall be reimbursed for services during the transitional period at the rate in effect when the transitional period clause is invoked by Harris County. During any transition period, all other terms and conditions of the contract shall remain in full force and effect as originally written and subsequently amended. DIGITAL FORMAT If offeror obtained the bid specifications in digital format in order to prepare a response, the proposal must be submitted in hard copy according to the instructions contained in this proposal package. If, in its proposal response, offeror makes any changes whatsoever to the County's published proposal specifications, the County's proposal specifications as published shall control. Furthermore, if an alteration of any kind to the County's published proposal specifications is only discovered after the contract is executed and is or is not being performed, the contract is subject to immediate cancellation.

DISQUALIFICATION OF OFFEROR Upon signing this bid document, an offeror offering to sell supplies, materials, services, or equipment to Harris County certifies that the offeror has not violated the antitrust laws of this state codified in Texas Business and Commerce Code §15.01, et seq., as amended, or the federal antitrust laws, and has not communicated directly or indirectly the bid made to any competitor or any other person engaged in such line of business. Any or all proposals may be rejected if the County believes that collusion exists among the offerors. Proposals in which the prices are obviously unbalanced may be rejected. If multiple proposals are submitted by an offeror and after the proposals are opened, one of the proposals is withdrawn, the result will be that all of the proposals submitted by that offeror will be withdrawn; however, nothing herein prohibits a vendor from submitting multiple proposals - for different products or services. E-MAIL ADDRESSES CONSENT Vendor affirmatively consents to the disclosure of its e-mail addresses that are provided to Harris County, the Harris County Flood Control District, the Harris County Hospital District including its HMO, the Harris County Appraisal District, or any agency of Harris County. This consent is intended to comply with the requirements of the Texas Public Information Act, Tex. Gov’t Code Ann. §552.137, as amended, and shall survive termination of this agreement. This consent shall apply to e-mail addresses provided by Vendor, its employees, officers, and agents acting on Vendor’s behalf and shall apply to any e-mail address provided in any form for any reason whether related to this bid/proposal or otherwise. EVALUATION Evaluation shall be used as a determinant as to which proposed items or services are the most efficient and/or most economical for the County. It shall be based on all factors which have a bearing on price and performance of the items in the user environment. All proposals are subject to negotiations by the Harris County Community Services Department with recommendation to the appropriate governing body. Compliance with all requirements, delivery and needs of the using department are considerations in evaluating proposals. Pricing is NOT the only criteria for making a recommendation. A preliminary evaluation by Harris County will be held and appropriate proposals will be subjected to the negotiating process and a request for a Best and Final Offer. Upon completion of the negotiations, Harris County will make an award. All proposals that have been submitted shall be available and open for public inspection after the contract is awarded except for trade secrets or confidential information contained in the proposals and identified as such. FISCAL FUNDING A multi-year lease or lease/purchase arrangement (if requested by the Special Requirements/Instructions), or any contract continuing as a result of an extension option, must include a fiscal funding out provision in the lease or contract. If, for any reason, funds are not appropriated by the applicable governing body to continue the lease or contract in their sole discretion, said lease or contract shall become null and void on the last day of the current appropriation of funds. After expiration of the lease, leased equipment shall be removed by the offeror from the using department without penalty of any kind or form to Harris County. All charges and physical activity related to delivery, installation, removal and redelivery shall be the responsibility of the offeror. GOVERNING FORMS In the event of any conflict between the terms and provisions of these requirements and the specifications, the specifications shall govern. In the event of any conflict of interpretation of any part of this overall document, Harris County's interpretation shall govern. GOVERNING LAW This request for proposal is governed by the competitive bidding requirements of the County Purchasing Act, Texas Local Government Code, §262.021 et seq., as amended. Offerors shall comply with all applicable federal, state and local laws and regulations. Offeror is further advised that these requirements shall be fully governed by the laws of the State of Texas and that Harris County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of these requirements. Forum for contractual issues shall be in Texas and venue shall be exclusively in Houston, Harris County, Texas, in a federal or state court of competent jurisdiction. The County does not agree to binding arbitration and does not waive its right to a jury trial. GRANT FUNDING Any contract entered into by the County that is to be paid from grant funds shall be limited to payment from the grant funding and the vendor/provider understands that the County has not set aside any County funds for the payment of obligations under a grant contract. If grant funding should become unavailable at any time for the continuation of services paid for by the grant, and further funding cannot be obtained for the contract, then the sole recourse of the provider shall be to terminate any further services under the contract and the contract shall be null and void.

HIPAA COMPLIANCE Offeror agrees to comply with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191 (codified at 45 C.F.R. Parts 160 and 164), as amended ("HIPAA"); privacy and security regulations promulgated by the United States Department of Health and Human Services ("DHHS"); Title XIII, Subtitle D of the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5, as amended ("HITECH Act"); provisions regarding Confidentiality of Alcohol and Drug Abuse Patient Records (codified at 42 C.F.R. Part 2), as amended; and TEX. HEALTH & SAFETY CODE ANN. §§ 81.046, as amended, 181.001 et seq., as amended, 241.151 et seq., as amended, and 611.001 et seq., as amended collectively referred to as "HIPAA", to the extent that the Offeror uses, discloses or has access to protected health information as defined by HIPAA. Offeror may be required to enter a Business Associate Agreement pursuant to HIPAA. HOLD HARMLESS AGREEMENT Contractor, the successful offeror, shall indemnify, defend, and hold Harris County harmless from all claims for personal injury, death and/or property damage resulting directly or indirectly from contractor's performance. Contractor shall procure and maintain, with respect to the subject matter of this proposal, appropriate insurance coverage including, as a minimum, public liability and property damage with adequate limits to cover contractor's liability as may arise directly or indirectly from work performed under terms of this proposal. Certification of such coverage must be provided to the County upon request. INSPECTIONS & TESTING Harris County reserves the right to inspect any item(s) or service location for compliance with specifications and requirements and needs of the using department. If an offeror cannot furnish a sample of a proposed item, where applicable, for review, or fails to satisfactorily show an ability to perform, the County can reject the proposal as inadequate. INVOICES AND PAYMENTS Offerors shall submit an original invoice on each purchase order or purchase release after each delivery, indicating the purchase order number. Invoices must be itemized. Any invoice, which cannot be verified by the contract price and/or is otherwise incorrect, will be returned to the offeror for correction. Under term contracts, when multiple deliveries and/or services are required, the offeror may invoice following each delivery and the County will pay on invoice. Contracts providing for a monthly charge will be billed and paid on a monthly basis only. Prior to any and all payments made for goods and/or services provided under this contract, the offeror should provide his Taxpayer Identification Number or social security number as applicable. This information must be on file with the Harris County Auditor’s office. Failure to provide this information may result in a delay in payment and/or back-up withholding as required by the Internal Revenue Service. MAINTENANCE Maintenance required for equipment proposed should be available in Harris County by a manufacturer-authorized maintenance facility. Costs for this service shall be shown on the Pricing/Delivery Information form. If Harris County opts to include maintenance, it shall be so stated in the purchase order and said cost will be included. Service will commence only upon expiration of applicable warranties and should be priced accordingly. MATERIAL SAFETY DATA SHEETS Under the "Hazardous Communication Act", commonly known as the "Texas Right To Know Act", an offeror must provide to the County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the offeror to furnish this documentation will be cause to reject any proposal applying thereto. NAME BRANDS Specifications may reference name brands and model numbers. It is not the intent of Harris County to restrict these bids in such cases, but to establish a desired quality level of merchandise or to meet a pre-established standard due to like existing items. Offerors may offer items of equal stature and the burden of proof of such stature rests with offerors. Harris County shall act as sole judge in determining equality and acceptability of products offered. NEW MILLENIUM COMPLIANCE All products and/or services furnished as part of this contract must be compliant for the present year and forward. This applies to all computers including hardware and software as well as all other commodities with date sensitive embedded chips. POTENTIAL CONFLICTS OF INTEREST An outside consultant or contractor is prohibited from submitting a proposal for services on a Harris County project of which the consultant or contractor was a designer or other previous contributor, or was an affiliate, subsidiary, joint venturer or was in any other manner associated by ownership to any party that was a designer or other previous contributor. If such a consultant or contractor submits a prohibited proposal, that proposal shall be disqualified on the basis of conflict of interest, no matter when the conflict is discovered by Harris County. Potential bidders are advised that they may have disclosure requirements pursuant to Texas Local Government Code, Chapter 176. This law requires persons desiring to do business with the County to disclose

any gifts valued in excess of $250 given to any County Official or the County Official’s family member, or employment of any County Official or the County Official’s family member during the preceding twelve (12) month period. The disclosure questionnaire must be filed with the Harris County Clerk. Refer to Texas Local Government Code, Chapter 176 for the details of this law. Contractor shall not use funds to directly or indirectly pay any person for influencing or attempting to influence any public employee or official in connection with the awarding of any contract or the extension, continuation, renewal, amendment or modification of any contract. Additionally, pursuant to 31 U.S.C.A. § 1352 (2003), if at any time during the contract term funding to contractor exceeds $100,000.00, contractor shall file with the County the Federal Standard Form LLL titled “Disclosure Form to Report Lobbying.” PROPOSAL FORM COMPLETION Fill out and return to the Harris County Community Services Department FIVE (5) complete proposal forms (two original and three copies) in an appropriately sized envelope or box. PACKAGE MUST SHOW THE RFP NAME, PROJECT DESCRIPTION AND BE MARKED “SEALED PROPOSAL.” An authorized representative of the offeror should sign the Proposal Cover Sheet. The contract will be binding only when signed by Harris County, funds are certified by the County Auditor and or the Hospital District, as applicable, and a Purchase Order issued. PROPOSAL RETURNS Offerors must return all completed proposals to the Harris County Community Services Department reception desk at 8410 Lantern Point Drive, Houston, Texas 77054 before 5:00 P.M. LOCAL TIME IN HOUSTON, TEXAS on the date specified. Late proposals will not be accepted for any reason. PURCHASE ORDER AND DELIVERY The successful offeror shall not deliver products or provide services without a Harris County Purchase Order, signed by an authorized agent of the Harris County Purchasing Department. The fastest, most reasonable delivery time shall be indicated by the offeror in the proper place on the Pricing/Delivery Information form. Any special information concerning delivery should also be included, on a separate sheet, if necessary. All items shall be shipped F.O.B. INSIDE DELIVERY unless otherwise stated in the specifications. This shall be understood to include bringing merchandise to the appropriate room or place designated by the using department. Every tender or delivery of goods must fully comply with all provisions of these requirements and the specifications including time, delivery and quality. Nonconformance shall constitute a breach which must be rectified prior to expiration of the time for performance. Failure to rectify within the performance period will be considered cause to reject future deliveries and cancellation of the contract by Harris County without prejudice to other remedies provided by law. Where delivery times are critical, Harris County reserves the right to award accordingly. RECYCLED MATERIALS Harris County encourages the use of products made of recycled materials and shall give preference in purchasing to products made of recycled materials if the products meet applicable specifications as to quantity and quality. Harris County will be the sole judge in determining product preference application. SCANNED OR RE-TYPED RESPONSE If in its response, offeror either electronically scans, re-types, or in some way reproduces the County's published proposal package, then in the event of any conflict between the terms and provisions of the County's published proposal package, or any portion thereof, and the terms and provisions of the response made by offeror, the County's proposal package as published shall control. Furthermore, if an alteration of any kind to the County's published proposal package is only discovered after the contract is executed and is or is not being performed; the contract is subject to immediate cancellation. SEVERABILITY If any section, subsection, paragraph, sentence, clause, phrase or word of these requirements or the specifications shall be held invalid, such holding shall not affect the remaining portions of these requirements and the specifications and it is hereby declared that such remaining portions would have been included in these requirements and the specifications as though the invalid portion had been omitted. SILENCE OF SPECIFICATIONS The apparent silence of specifications as to any detail, or the apparent omission from it of a detailed description concerning any point, shall be regarded as meaning that only the best commercial practice is to prevail and that only material and workmanship of the finest quality are to be used. All interpretations of specifications shall be made on the basis of this statement. The items furnished under this contract shall be new, unused of the latest product in production to commercial trade and shall be of the highest quality as to materials used and workmanship. Manufacturer furnishing these items shall be experienced in design and construction of such items and shall be an established supplier of the item proposed.

SUPPLEMENTAL MATERIALS Offerors are responsible for including all pertinent product data in the returned proposal package. Literature, brochures, data sheets, specification information, completed forms requested as part of the proposal package and any other facts which may affect the evaluation and subsequent contract award should be included. Materials such as legal documents and contractual agreements, which the offeror wishes to include as a condition of the proposal, must also be in the returned proposal package. Failure to include all necessary and proper supplemental materials may be cause to reject the entire proposal. TAXES Harris County is exempt from all federal excise, state and local taxes unless otherwise stated in this document. Harris County claims exemption from all sales and/or use taxes under Texas Tax Code §151.309, as amended. Texas Limited Sales Tax Exemption Certificates will be furnished upon written request to the Harris County Purchasing Agent. TERM CONTRACTS If the contract is intended to cover a specific time period, the term will be given in the specifications under SCOPE. TERMINATION Harris County reserves the right to terminate the contract for default if offeror breaches any of the terms therein, including warranties of offeror or if the offeror becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies which Harris County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Harris County's satisfaction and/or to meet all other obligations and requirements. Harris County may terminate the contract without cause upon thirty (30) days written notice. TERMINATION FOR HEALTH AND SAFETY VIOLATIONS Harris County has the option to terminate this contract immediately without prior notice if offeror fails to perform any of its obligations in this contract if the failure (a) created a potential threat to health or safety or (b) violated a law, ordinance, or regulation designed to protect health or safety. TITLE TRANSFER Title and Risk of Loss of goods shall not pass to Harris County until Harris County actually receives and takes possession of the goods at the point or points of delivery. Receiving times may vary with the using department. Generally, deliveries may be made between 8:30 a.m. and 4:00 p.m., Monday through Friday. Offerors are advised to consult the using department for instructions. The place of delivery shall be shown under the "Special Requirements/Instructions" section of this proposal package and/or on the Purchase Order as a "Deliver To:" address. WAIVER OF SUBROGATION Offeror and offeror's insurance carrier waive any and all rights whatsoever with regard to subrogation against Harris County as an indirect party to any suit arising out of personal or property damages resulting from offeror's performance under this agreement. WARRANTIES Offerors shall furnish all data pertinent to warranties or guarantees which may apply to items in the proposal. Offerors may not limit or exclude any implied warranties. Offeror warrants that product sold to the County shall conform to the standards established by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970. In the event product does not conform to OSHA Standards, where applicable, Harris County may return the product for correction or replacement at the offeror's expense. If offeror fails to make the appropriate correction within a reasonable time, Harris County may correct at the offeror's expense.

VENDORS OWING TAXES OR OTHER DEBTS Pursuant to TX Local Government Code 262.0276, Harris County Commissioners Court has adopted a policy which requires that vendors’ taxes and other Harris County debts be current as of the date bids/proposals are due. Bidders with delinquent county taxes or other county debts on the due date will not be eligible for award. Whether or not a vendor’s taxes are delinquent will be determined by an independent review of the Tax Office records. Prior to submitting an offer, vendors are encouraged to visit the Tax Office website at www.hctax.net, set up a portfolio of their accounts and make their own initial determination of the status of their tax accounts. Vendors who believe a delinquency is reflected in error must contact the Tax Office to correct any errors or discrepancies prior to submitting their offer in order to ensure that their offer will be considered. Furthermore, if, during the performance of this contract, a vendor’s taxes become delinquent or a vendor becomes otherwise indebted to Harris County, Harris County reserves the right to provide notice to the Auditor or Treasurer pursuant to Texas Local Government Code §154.045. This policy is effective for all bids/proposals due on or after November 1, 2009.

Revised 3/18

TAX FORM/DEBT/RESIDENCE CERTIFICATION (for Advertised Projects)

Taxpayer Identification Number (T.I.N.): Company Name submitting Bid/Proposal: Mailing Address: Are you registered to do business in the State of Texas? Yes No If you are an individual, list the names and addresses of any partnership of which you are a general partner or any assumed name(s) under which you operate your business

I. Property: List all taxable property in Harris County owned by you or above partnerships as well as any d/b/a names. (Use a second sheet of paper if necessary.)

Harris County Tax Acct. No.* Property address or location**

* This is the property account identification number assigned by the Harris County Appraisal District. ** For real property, specify the property address or legal description. For business personal property, specify the address

where the property is located. For example, office equipment will normally be at your office, but inventory may be stored at a warehouse or other location.

II. Harris County Debt - Do you owe any debts to Harris County (taxes on properties listed in I above, tickets,

fines, tolls, court judgments, etc.)?

Yes No If yes, attach a separate page explaining the debt. III. Residence Certification - Pursuant to Texas Government Code §2252.001 et seq., as amended, Harris County

requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contracts; pertinent provisions of §2252.001 are stated below:

(3) "Nonresident bidder" refers to a person who is not a resident.

(4) "Resident bidder" refers to a person whose principal place of business is in this state, including a

contractor whose ultimate parent company or majority owner has its principal place of business in this state.

I certify that . is a Resident Bidder of Texas as defined in Government [Company Name] Code §2252.001.

I certify that is a Nonresident Bidder as defined in Government Code [Company Name]

§2252.001 and our principal place of business is . [City and State]

Revised 11/09

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MINIMUM INSURANCE REQUIREMENTS During the term of the Contract, the Contractor at its sole expense shall provide primary commercial insurance of such type and with such terms and limits as may be reasonably associated with the Contract. As a minimum, the Contractor shall provide and maintain the following coverage and limits: A. Workers Compensation, as required by the laws of Texas, and Employers’ Liability, as well as All States, USL&H and

other endorsements if applicable to the project, and in accordance with state law.

Employers’ Liability Each Accident: $1,000,000 Disease–Each Employee: $1,000,000 Policy Limit: $1,000,000

B. Commercial General Liability, including but not limited to the coverage indicated below. Coverage shall not contain any

restrictive endorsements nor exclude or limit Products/Completed Operations, Contractual Liability, or Cross Liability. Where exposure exists, the County may require coverage for watercraft, blasting, collapse, explosions, blowout, cratering, underground damage, pollution, or other coverage. Harris County shall be named Additional Insured on primary/non-contributory basis.

Each Occurrence: $1,000,000 Personal and Advertising Injury: $1,000,000 Products/Completed Operations: $1,000,000 General Aggregate (per project): $2,000,000

C. Automobile Liability, including coverage for all owned, hired, and non-owned vehicles used in connection with the Contract.

Harris County shall be named Additional Insured on primary/non-contributory basis. Combined Single Limit-Each Accident: $1,000,000

D. Umbrella/Excess Liability (Harris County shall be named Additional Insured on primary/non-contributory basis)

Each Occurrence/Aggregate: $1,000,000 E. Professional/Errors & Omissions Liability (if applicable)

Each Occurrence/Aggregate: $1,000,000 The County reserves the right to require additional insurance if necessary. Coverage shall be issued by companies licensed (by TDI) to do business in Texas, unless said coverage is not available or economically feasible except through an excess or surplus lines company, in which case the company should be registered to do business in Texas. Companies shall have an A.M. Best rating of at least A-VII. Contractor shall furnish evidence of such insurance to the County in the form of unaltered insurance certificates. If any part of the contract is sublet, insurance shall be provided by or on behalf of any subcontractor, and shall be sufficient to cover their portion of the contract. Contractor shall furnish evidence of such insurance to the County as well. Policies of insurance required by the contract shall waive all rights of subrogation against the County, its officers, employees and agents. If any applicable insurance policies are cancelled, materially changed, or non-renewed, contractor shall give written notice to the County at least 30 days prior to such effective date and within 30 days thereafter, shall provide evidence of suitable replacement policies. Failure to keep in force the required insurance coverage may result in termination of the contract. Upon request, certified copies of original insurance policies shall be furnished to the County. The requirements stipulated in this attachment do not establish limits of contractor liability. Revised 8/2017

Late proposals will NOT be accepted

Program Specific Instructions

Available Funding and Form of Assistance

Site Control

Service Area and Site Selection

Harris County Community Services Department 8410 Lantern Point Drive, Houston, Texas 77054

Harris County Community Services Department (HCCSD) will administer the Affordable Rental Housing Program forinterested eligible entities to apply for the Community Development Block Grant-Disaster Recovery (CDBG-DR) fundingallocated to Harris County by HUD and the State of Texas General Land Office. HCCSD determines the form of assistanceto be provided to affordable housing projects. Eligible forms of subsidy include: 1) Grants for non-profits and CommunityHousing Development Organizations (CHDOs) and Community Based Development Organizations (CBDOs) and 2) Loansthat can be forgivable and interest bearing or non-interest bearing. See Harris County Affordable Housing Standards for more information, found on Harris County CSD website athttps://csd.harriscountytx.gov/Pages/rfq.aspx.

All applicants must be able to document site control , which may include a deed of trust or agreement of sale. Inability todocument site control may result in elimination during the threshold review.

Harris County's CDBG-DR service area includes 33 incorporated cities and unincorporated Harris County, excluding the City of Houston. CDBG-DR funded rental housing developments must be located outside the City of Houston unless the project is serving the homeless. Homeless housing projects within the cith must receive a significant contribution from the City of Houston to be eligible. Applicants must provide documentation of the significant contribution such as a grant allocation, waiver of fees, or other contribution of monetary value from the city. Developments must comply with the Harris County Affordable Multi-unit Family and Senior Housing Concentration Policy. Developments are encouraged to locate in High Opportunity Zones (as mapped by Harris County) and areas of documented revitalization efforts. Neighborhood/Community Revitalization is demonstrated by other public and/or private investments in an area to improve the infrastructure, housing, public facilities, and/or provision of government services. Other High Priority areas for CDBG-DR funding include the Greenspoint area (outside the city of Houston), Aldine ISD, Sheldon ISD, Cy-Fair ISD and areas of Pasadena and South Houston with high rental unit damage.

Harris County Request for ProposalsCommunity Development Block Grant (CDBG) Disaster Recovery Affordable Rental Housing Program

Application Instructions

Application Quick Reference GuideHarris County has made available through the Application Quick Reference Guide (QRG) located on the CDBG-DR Application QRG Tab, a reference point that provides general instruction regarding policies that apply to all organizations and all funding types. These policies include eligible applicants, tax policy, conflict of interest, review criteria, monitoring and recordkeeping. Please also review our website at https://csd.harriscountytx.gov/Pages/rfq.aspx to become familiar with Harris County's Affordable Housing Standards and other frequently asked questions about the Harris County application process.

Application Release Date: September 11, 2018Total CDBG-Disaster Recovery Funding RFP: $200,000,000 (Max. of $25,000,000 per project)

Applications will be due no later than March 1, 2019 and can be submitted at anytime before due date.

Harris County Supplemental Action Plan Proposed projects must work to meet the needs identified and specific program requirements stated in the Harris County Supplemental Action Plan (SAP) for Hurricane Harvey Community Development Block Grant Disaster Recovery Funding (Round One) as approved by the Texas General Land Office. Harris County's SAP is located on HCCSD's website at https://csd.harriscountytx.gov/Pages/DisasterRecovery.aspx

Instructions 1

Security and Land Use Restrictions

Leverage/Match Requirement

Affordable Housing Standards

Project Resiliency and Mitigation

Funding of Affordable Housing Projects is secured by Deeds of Trust to Secure Performance and Regulatory Agreementsand Declaration of Restrictive Covenants (RC). The subordination of the Deed of Trusts to Secure Performance to thefinancing for the construction and development of the projects is acceptable. In the event that there are multiple fundingsources for a project, the County's RC will not be subordinated to other entity liens, regardless of amount of funds provided.Intercreditor Agreements are required when more than one (1) entity is providing funding for a project, with the County's RCremaining unsubordinated. The Intercreditor Agreement will establish lien position and require that senior lenders notify theCounty in the event a senior lender learns of a default under a senior loan for the project and require senior lenders toprovide the County an opportunity to cure a default on a project loan.

Green Building/Re-building StandardsHarris County requires compliance with the most recent version of the International Code Council's (ICC) International Building Code and compliance with Energy Star requirements. Harris County does not require developments to obtain LEED certification from the U.S. Green Building Council but encourages developments to include LEED elements that will enhance the project and result in a more sustainable development.

All affordable housing projects requesting Harris County funding will be required to meet the Affordable Housing DesignStandards posted on the Community Services Department (HCCSD) website athttps://csd.harriscountytx.gov/Pages/rfq.aspx. Review of this document is critical to ensure compliance with projectspecifics such as building placement, unit size and proximity to amenities. Prior to application submission, applicantsproposing new construction of multifamily housing and senior housing are encouraged to contact HCCSD for projectevaluation to ensure proper dispersal of subsidized multi-unit housing throughout the County’s service area and compliancewith the concentration policy.

Design PlansSchematic Design plans are required with application submission . Following a funding recommendation, awardedprojects will be expected to submit nearly complete, but not yet approved, construction plans reflecting details on EnergyStar Certification, landscaping and all other construction specifics within 60 days of award.

A minimum leverage amount of 20 percent of the total project costs is required. Leverage funding serves as asupplement to the overall project budget and is in addition to the requested CDBG-DR funding amount. Examples ofleveraging include but are not limited to cash, loans from other sources, value of property acquired without CDBG-DRfunds, the value of engineering and/or architectural services not paid for with CDBG-DR funds and property tax exemptionsgranted by applicable taxing jurisdictions.

Accessible unitsDevelopments must comply with current ADA Standards with current ADA Standards and Section 504 requirements, which includes a requirement that 5 percent of the dwelling units be accessible for persons with mobility disabilities and an additional 2 percent must be accessible for persons with hearing or visual disabilities. In addition to the minimum Section 504 requirements, for new construction and major rehabilitation projects two additional mobility accessible and one additional vision/hearing accessible unit be required.

Harris County will not only assess projects and consider a proposed project's ability to replace or repair lost units, but will also seek to invest CDBG-DR funds into projects that promise to mitigate damage from a wide range of future disaster types and create a more resilient housing stock and community. Multi-family resiliency solutions include but are not limited to elevation; retention basins; fire-safe landscaping; firewalls; and landscaped floodwalls. HCCSD requires compliance with IBHS's FORTIFIED Home Silver Level.

Instructions 2

Capital Needs Assessment

Contractor Procurement

Underwriting HUD requires underwriting and subsidy layering analysis (when applicable) to be performed on the initial application,initial closing, or construction start, and again at construction completion or final draw.

Project Timeliness

Monitoring Fee

For rental rehabiliation projects of 26 units or more, a capital needs assessment is required and must be submitted to HCCSD with the proposal.

1) Developments are required where possible to comply with HUD guidance (Notice PIH 2015-19) on excluding the use of arrest records in housing decisions. 2) Developments must accept a Housing Choice (Section 8) Vouchers. 3) Developments are required to register their rental development and units with the Harris County Housing Search tool maintained by HCCSD's Housing and Community Resource Center.4) In the event of future disasters that impact Harris County, the rental development will provide reporting of building/unit conditions and status of available units for county damage assessments and to assist disaster recovery Housing programs for displaced county residents to Harris County Community Services Department upon request.

Harris County has implemented a Monitoring Fee Policy for multi-unit rental projects. This fee is an annual fee throughoutthe affordability period to allow for the long-term monitoring of the project during the affordability period. The fee is $50.00per County-assisted unit annually for each year of the affordability period. The fee is calculated in the project's Pro FormaSection of this application. For more information regarding the monitoring fee, please see HCCSD's Funding GuidelinesPage at http://www.csd.hctx.net/rfq.aspx.

Other Requirements Related to Occupancy and Leasing

CDBG-DR funding has an expenditure deadline of six years after the date of the approval of the State's Hurricane Harvey Round One Action Plan which was approved June 25, 2018. Projects must be able to execute a contract within 6 months of receiving an award, must break ground on construction or complete acquisition within 12 months of contract execution and project construction must be completed within 18 months of the effective contract date unless otherwise extended with Harris County’s approval.

Certificate of Interested Parties (Form 1295)Texas law requires all parties who enter into any contract with the County which must be approved byCommissioners Court to disclose all interested parties. Form 1295 must be completed in its entirety at thefollowing website: https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm prior to submittingyour response. Failure to do so may result in disqualification of your response. A copy of the form must be returned with the application.

Harris County requires the procurement of all contractors and subcontractors through a process that complies with theUniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards found at 2 CFR Part200 and other applicable federal, state and local procurement guidelines. Proper procurement, as monitored by HCCSD,ensures steps are taken to eliminate potential conflict of interest issues when hiring contractors. Developers should notethat procurement policy allows a cost reasonable analysis to be performed in lieu of a sealed bid procurement process forcontractors. Policy also requires that all selected general contractors must be bonded.

Supportive Housing Set-AsideDevelopments must set-aside a minumum of 5 units for clients/residents referred by the Supportive Housing System or other referral system approved by the County. If a referral is not made within 30 days of notification of unit availaiblity by referral agency, the housing provider may fill the vacant unit with an eligible resident.

Instructions 3

Harris County Request for ProposalsCommunity Development Block Grant (CDBG) Disaster Recovery Program Affordable Rental Housing Program

Application Quick Reference Guide (QRG)

The Harris County Community Services Department (HCCSD) invites qualified organizations with eligible projects to apply forfunds for acquisition, rehabilitation, reconstruction, and new construction of affordable multi-family housing projects thatimprove rental conditions in areas impacted by Hurricane Harvey. Harris County seeks organizations that can demonstratethe capacity to assist the Department in meeting the needs for those renter households that reported damage to their housingunits and personal property. Due to the extensive need in the community and limited time that funding is available, allCDBG-DR Projects must execute contract within 6 months of award and must break ground on construction orcomplete acquisition within 12 months of contract execution. Project construction must be completed within 18months of the effective date of the contract, unless otherwise extended.

Prior to responding to the application, each qualified organization is urged to review this reference guide and read theinstructions carefully. Before submitting the application, review the Application Checklist, check all calculations and review thepackage to ensure that all sections are complete and required forms are included. Inaccuracies, omissions and use ofapplication forms from previous competitions will be grounds for rejection. All proposals will become part of Harris County’sofficial files, and if awarded, will be incorporated by reference into an Agreement with Harris County. For additionalinformation see the Harris County CSD's website at: https://csd.harriscountytx.gov/Pages/rfq.aspx.

Application Submittal Instructions• Please visit our website at https://csd.harriscountytx.gov/Pages/FundingOpportunities.aspx under the FundingOpportunities page or email [email protected] for additional information and to check for updates.

• Submit no more than three (3) project proposals in response to the CDBG Disaster Recovery Affordable Rental HousingProgram RFP. If submitting more than one proposal, prioritize each application (Priority 1, Priority 2 or Priority 3). Indicate thePriority on the first page of each application.

• Bind only with binder clips. Insert labeled tabs for the sections as outlined in the Application Checklist. Do not use stickynotes as a substitute for tabbed dividers.

• Submit five (5) hard copies (two originals and three copies) and an electronic copy of the complete application and budgetforms on a flash drive (USB) in their original format. Indicate whether the proposal is an original or copy on the first page ofeach paper application. All proposals must:1) Include all attachments in their entirety as outlined on the Application Checklist.2) All applications must be signed by the organization’s Board Chair/Executive Director/President or Designee. Unsigned applications will not be accepted. 3) Include “Harris County Affordable Rental Housing CDBG-DR RFP 2018” on the outside of its sealed envelope. Each

copy of the proposal must be in an individually sealed envelope clearly marked as “Original” or “Copy.”4) Copies should NOT have any form of binding or be submitted in a folder/binder, but held together with binder clips.5) All originals must be signed in blue ink and clearly noted "Original".

HCCSD CDBG-DR RFPQRG Page 4


Harris County Service Area CDBG-DR funded affordable rental housing projects may be located anywhere within Harris County, including any citieswithin the county except within the City of Houston. Homeless housing projects may be located throughout Harris County,including inside the City of Houston. For projects serving the homeless, the City of Houston must provide a significantcontribution for the project to be eligible for County CDBG-DR funds. Applicants must provide documentation of the significantcontribution such as a grant allocation, waiver of fees, or other contribution of monetary value from the city. Proposeddevelopments must also be in compliance with the Harris County Mulit-Unit Family and Senior Housing Concentration Policyavailable here: https://csd.harriscountytx.gov/Pages/LIHTC.aspx. Projects that are not can request a waiver that is subjectto approval by the Executive Director. Applicants can contact Development staff to inquire if their proposed development isconsistent and located within the Harris County CDBG-DR Service Area. Harris County has High Priority areas for CDBG-DRfunding within its service area that include the Greenspoint area (outside the city of Houston), Aldine ISD, Sheldon ISD, Cy-Fair ISD and areas within the cities of Pasadena and South Houston with high rental unit damage.

Harris County Supplemental Action Plan Proposed projects must work to meet the needs identified and specific program requirements stated in the Harris CountySupplemental Action Plan (SAP) for Hurricane Harvey Community Development Block Grant Disaster Recovery Funding(Round One) as approved by the Texas General Land Office. Harris County's SAP is located on HCCSD's website athttps://csd.harriscountytx.gov/Pages/DisasterRecovery.aspx

Application Process

All applicants must complete the application in a professional manner, with all sections completed in their entirety, as well as demonstrate knowledge and experience in the area of the program proposed. Applicants must also retain any required licensing and other qualifications needed to carry out the proposed program. Housing developments must comply with the Harris County Affordable Housing Standards, which can be found on the Harris County CSD website at https://csd.harriscountytx.gov/Pages/rfq.aspx.

Organizations must demonstrate financial viability and capacity to operate a federally-funded program strictly on a reimbursement basis. A financially viable organization is one that is able to: • Operate for four to six months pending reimbursement without financial hardship• Demonstrate an existing and consistent cash flow• Have a separation of duties for personnel, time allocations, etc.

Organizations that are current subrecipients must be in good standing with the County (i.e. have no outstanding reporting delinquencies, monitoring findings, or program capacity issues) to be considered for funding.

Limitations of the RFPHCCSD reserves the right to accept or reject any and all proposals received. In addition, Harris County reserves the right tonegotiate with all qualifying organizations or to cancel in whole or in part an application if deemed in the best interest of HarrisCounty as it relates to the Supplemental Action Plan. Organizations may participate in negotiations and resubmit anyproposed expenses, technicality, or other revisions of their proposal as requested by HCCSD. HCCSD has the right to waiveor adjust RFP requirements and specifications on a case-by-case basis after submission of an application.



Available FundsThe information below provides an estimate of how funds will be distributed based on available funding and the allocation of CDBG-DR funding from the U.S. Department of Housing and Urban Development (HUD) via the Texas General Land Office. Allocation information can be found in the Harris County SAP on HCCSD's website at https://csd.harriscountytx.gov/Pages/DisasterRecovery.aspx.

Harris County has set-aside Community Development Block Grant-Disaster Recovery Housing Funding (CDBG-DR) of $200,000,000 from the County's allocation for the Affordable Rental Housing Program as stated in the SAP. Of this set-aside, $100,000,000 has been prioritized for developments by local housing authorities located in Harris County or developments that partner with a local housing authority. Proof of partnership/collaboration must be documented and included with the application. There will be a maximum award of $25 million per development (Harris County may request a waiver to exceed this limit on a case by case basis). The first award is anticipated to occur on or about January 2019, and onward until available funding is exhausted. Harris County reserves the right to reallocate funding between categories to insure funding of the most qualified projects that best address community needs as reflected in the Supplemental Action Plan.

Eligible ApplicantsNon-profit organizations (including faith-based organizations providing services in a secular manner), for-profit developers of affordable housing, municipalities and local governments who deliver services to low-income clients within Harris County’s service area may apply for funding. All non-profit organizations must have non-profit status with supporting documentation from the IRS at the time of application to be considered for funding through Harris County. Applicants must be in good standing with all housing authority programs. Harris County will verify debarment status through the System for Award Management (SAM) and the Office of Foreign Assets Control’s Specially Designated National and Blocked Persons List. Applicants listed as debarred in either system may not be considered for funding through Harris County. Eligible Applicants may also include those acting individually or as participants in a limited partnership (LP) or limited liability corporation (LLC).

Note: Harris County encourages proposals that include partnership with local housing authorities in the County.

Tax Policy for all ApplicantsPursuant to TX Local Government Code 262.0276, Harris County requires that all applicants’ taxes be current to be eligiblefor assistance. Whether or not an applicant’s taxes are delinquent will be determined by an independent review of the TaxOffice records. Applicants who believe a delinquency is reflected in error must contact the Tax Office to correct any errors ordiscrepancies prior to submitting their proposal in order to ensure that their proposal will be considered. Tax records areavailable online at the Tax Office website found at www.hctax.net. Delinquent tax status of organizations and property can befound at http://www.hctax.net/Property/DelinquentTax. Prior to submitting a proposal, applicants are encouraged to visitthe Tax Office website, set up a portfolio of their accounts and make their own initial determination of the status of their taxaccounts. Furthermore, if during the performance of this contract, an applicant’s taxes become delinquent, Harris Countyreserves the right to provide notice to the Auditor or Treasurer pursuant to Texas Local Government Code §154.045.

Disbursement of FundsHarris County funds are provided to awarded organizations on a reimbursement basis only, except in the case of acquisitionprojects where funding may be provided at closing. This means that funds will be available to the organization after it has paidfor eligible project costs; however, no costs incurred prior to contract approval may be reimbursed. Harris County requires thatorganizations provide documentation that they will have at least four months (120 days) of working capital or have an openline of credit through a financial institution to cover project costs. Working capital must be in the form of liquid assets. Futurefunding through donations, capital campaigns, fundraising or other grant sources are not considered working capital.Organizations must follow the applicable standards in OMB Super Circular (2 CFR 200 - Uniform AdministrativeRequirements, Cost Principles, and Audit Requirements for Federal Awards) to receive reimbursement.



Conflict of InterestThe standards in OMB Super Circular (2 CFR 200 - Uniform Administrative Requirements, Cost Principles, and AuditRequirements for Federal Awards), provide that no employee, officer, or agent shall participate in the selection, award, oradministration of a contract supported by Federal funds if a real or apparent conflict of interest would be involved. Such aconflict would arise when an employee, officer, or agent, any member of his or her immediate family, his or her partner, or anorganization which employs or is about to employ any of the parties indicated herein, has a financial or other interest in thefirm selected for an award. All organizations must complete and submit the Conflict of Interest Disclosure section of theapplication to document any perceived or actual conflict of interest.

Eligibility CriteriaThe proposed project should:• Development must meet CDBG-DR eligibility requirements. • Development must be located within Harris County and outside the city limits of Houston except that in certain cases where the City and County partner on projects that projects that provide housing for homeless populations.• Provide a minimum of 20 percent leverage based on total project cost (additional leverage encouraged).• Be an eligible applicant type as stated in the Eligible Applicants section on QRG page 3. • A minimum of 51 percent of the units must be restricted for twenty (20) or more years of an affordability period for low- and moderate-income (LMI) individuals earning 80 percent or less of the Area Median Family Income (AMFI) at affordable rents. Of the 51 percent of units that are restricted, Harris County provides the table of restricted units by income category.



Low-to-Moderated Income (LMI)Low-to-moderate income is defined as earning less than 80 percent of the area median family income (MFI). The 2018 MFIfor the Houston, Texas, Primary Metropolitan Statistical Area for a family of four is documented in the table below. Pleasenote that these limits are updated annually and applicants should be aware of the most recent limits.

Source: www.huduser.gov/portal/datasets/il/il2018/2018summary.odn

RentsUnits designated to meet the affordability requirement (minimum of 51% of total units) must comply at minimum with High andLow HOME rents published by HUD under the HOME program. For households with an Area Median Family Income (AMFI)at 30% or below, rent will be basd on 60% of the current Low HOME rent value rounded to the nearest whole dollar. Rentsmust comply with the applicable rent limit through the affordability period and compliance with the rent limit is calculated in thesame manner as the HOME program. Tenant-paid rent, plus utility allowance, plus rental assistance (if any) must be underthe High HOME or HUD-approved rent limit.

Income Targeting of RentsIncome Targeting shall require that developments provide at least 15% of units to households with income at 30% or less ofAMFI as published annually for Harris County by HUD and the Texas Department of Housing and Community Affairs(TDHCA). This targeting also includes 22% of units are restricted to households at 50% AMFI or less and assigned theapplicable Low HOME rent amount based on household size. All remaining income restricted units must comply with HighHOME rent for the applicable household size. See the 2018 TDHCA Rent and Income Limits table below for rent amounts.These amounts will be update annually by HUD and TDHCA. Rents must also comply with other existing Land UseRestriction Agreement (LURA) restrictions, if applicable.



Property TypesRental developments that are eight (8) or more rental units under common ownership are eligible.

Design CriteriaSubmission of design plans are critical to understanding the proposed project and allowing for a thorough review. All applicants submitting a construction oriented proposal are required to submit a minimum of Schematic Design plans with their application. If the project is also applying for LIHTC/bonds from TDHCA, and if a funding recommendation is made for the project, the applicant will be expected to submit nearly complete, but not yet approved, construction plans reflecting details on Energy Star Certification, landscaping and all other construction specifics and standards within 60 days of award from Harris County. For an additional reference please refer to the Affordable Housing Standards: https://csd.harriscountytx.gov/Pages/rfq.aspx.

Accessible unitsDevelopments must comply with current ADA Standards and Section 504 requirements, which includes a requirement that 5 percent of the dwelling units be accessible for persons with mobility disabilities and an additional 2 percent must be accessible for persons with hearing or visual disabilities. In addition to the minimum Section 504 requirements, for new construction and major rehabilitation projects, two additional mobility accessible and one additional vision/hearing accessible unit be required.

Supportive Housing Set-AsideDevelopments must set-aside a minumum of 5 units for clients/residents referred by the Supportive Housing System or other referral system approved by the County. If a referral is not made within 30 days of notification of unit availaiblity by referral agency, the housing provider may fill the vacant unit with an eligible resident.

Financing Terms for Affordable Housing Developments Harris County financing terms are described in the Harris County Affordable Housing Standards, which can be found on theHarris County CSD website at https://csd.harriscountytx.gov/Pages/rfq.aspx. The County desires to provide enoughfunding to each approved transaction to increase the availability of affordable units, or substantially improve the quality ofexisting units, without over-subsidizing (enriching) the development or increasing the risk associated with over-leveraging thedevelopment (too much debt for the restricted rents to support). The County reserves the right to determine award andfinancing terms based on the financial evaluation of the transaction in tandem with the program requirements and availabilityof funds. When securing other financing after the application for CDBG-DR funds, owners, developers and sponsors mustensure that awards and commitments, even those of non-HUD funds, are conditioned upon receipt of CDBG-DR funds.Applicants may not transfer ownership of the asset, or refinance its debt, throughout the affordability period except with theexpress consent of Harris County CSD Executive Director.

The County’s Land Use Restriction Agreement (LURA) must be superior to all other liens. In most cases the County’s loanposition will be junior to Senior Debt; however the County reserves the right to have a position senior to other sources offinancing. A LURA requires that the rents charged to tenants are based upon the renter’s income as a percentage of AdjustedMedian Income (AMI) established annually by HUD. The LURA also defines the number of units which must be restricted andto which income groups (“restricted units”). These covenants must be in a lien position superior to all other debt, includingexisting debt, and will require any existing lender to subordinate to the rent restrictions.

Developments Directly Damaged by Hurricane HarveyHarris County and the Texas General Land Office are required by federal regulations to avoid the duplication of benefits.No disaster recovery assistance will be considered with respect to any part of a disaster loss that is reimbursable by theFederal Emergency Management Agency (FEMA), the Army Corps of Engineers (USACE), insurance, or another source duein part to the restrictions against duplication of benefits outlined in Supplemental Action Plan. If a development was directlydamaged by Hurricane Harvey (flooding, wind, lightning, etc.), then documentation must be provided for all applicable publicand private reimbursements received and all applicable claim denials.



Fair Housing and Equal Access to Housing Title VIII of the Civil Rights Act of 1968 (Fair Housing Act), as amended prohibits discrimination in the sale, rental, andfinancing of dwellings, and in other housing-related transaction, and provides equal access to housing. As required by theU.S. Department of Housing and Urban Development (HUD), Harris County must produce and implement a Fair HousingPlan that includes an analysis of Impediments to Housing Choice. Harris County’s Fair Housing Plan can be found on theCSD website at https://csd.harriscountytx.gov/Pages/HCFairHousingPlan.aspx. The Fair Housing Plan sets severalstrategies to improve housing choice in addition to elimination of housing overt discrimination, these include strategies toimprove the quality of community amenities and services. CSD encourages all organizations to review the Harris County FairHousing Plan and the HUD Fair Housing Planning Guide at http://www.hud.gov/offices/fheo/images/fhpg.pdf and createstrategies for your organization to encourage Fair Housing in Harris County.

On February 3, 2012, HUD published a final rule in the Federal Register entitled Equal Access to Housing in HUD Programsregardless of Sexual Orientation or Gender Identity. The rule creates a new regulatory provision that generally prohibitsconsidering a person’s marital status, sexual orientation, or gender identity (a person’s internal sense of being male orfemale) in making housing assistance available. Now lesbian, gay, bisexual, and transgender people are guaranteed equalaccess to all housing for all types of housing (affordable, permanent, transitional and emergency) funded through HUD.

On September 21, 2016, HUD published a final rule in the Federal Register entitled "Equal Access in Accordance with anindividual's Gender Identity in Community Planning and Development Programs." This rule builds upon the 2012 EqualAccess Rule. The final rule requires that recipients and subrecipients of CPD funding, as well as owners, operators, andmanagers of shelters, and other buildings and facilities and providers of services funded in whole or part by any CPD programto grant equal access to such facilities, and other buildings and facilities, benefits, accommodations, and services toindividual's gender identity, and in a manner that affords equal access to the individual's family. For additional guidanceplease refer to: https://www.hudexchange.info/resources/documents/Equal-Access-Final-Rule-2016.pdf

All recipients of Harris County CDBG-DR funding must also comply with HUD’s Final Rule on Violence Against WomenReauthorization Act of 2013 (VAWA). This rule protects housing of survivors of domestic and dating violence, sexual assaultand stalking. Additional information regarding HUD’s Final Rule on Violence Against Women Reauthorization Act of 2013 canbe found at: https://www.hudexchange.info/news/hud-announces-publication-of-final-rule-implementing-vawa-reauthorization-act-of-2013/.Additional information on Fair Housing and Gender Identifying Terms can be found on attachments A & B respectively.



Review CriteriaAt the time of submission, all applications are reviewed by Harris County staff for eligibility based on a number of thresholdfactors. While evaluating applications for initial eligibility, reviewers use the following established criteria: Does the project meet a National Objective and/or applicable program objective? Is project located within the Harris County CDBR Disaster Recovery service area (outside the City of Houston)? Does project include the required percentage and eligible leverage funds? Is the application complete and is all of the requested information included in the application? Has the organization been debarred or owe outstanding taxes? Is the organization listed with the Office of Foreign Assets (OFAC) as engaging in terrorist activities? Does the organization have an active System of Award Management (SAM.gov) account? The second phase of the review process addresses the specific projects being proposed. The following criteria are used inmaking project recommendations:

Compliance with Harris County's Supplemental Action Plan Completeness of proposal Diversity of funding base Prior history with federal funds Availability of working capital Need and community impact Program administration and operational expenses Submission of design plans (minimum of schematic design) Organizational capacity Financial capacity/underwriting Duplication of services Geographic distribution of projects Past and current performance/Risk Assessment Projected outcomes Reasonable projected costs Leveraging and/or matching funds Location of the project relative to environmental concerns (flood plain, highways, railroads)

If applicable: Construction work descriptions, design plans, schedules, photos and cost estimates Relocation policy Marketing plans (required) Other program required information (i.e.: Davis-Bacon Labor policy, Affirmative Marketing Plan, participation of a homeless or previously homeless person in policy and decision making, and Minority Outreach Plan, Lead-Based Paint, etc.) HCCSD will use its discretion to select projects that will be visited during the RFP process. Site visits should accurately reflect the descriptions provided in the application. Compliance with additional Harris County set-aside requirements - Supportive Housing unit set-aside - Accessible Units (ADA/Section 504) set-aside - Income Restricted Unit set-aside

Application Scoring Exhibit A: Applicant Information: 5 pointsExhibit B: Organizational Capacity: 20 pointsExhibit C: Project Information: 30 pointsExhibit D: Project Compliance and Scope of Services: 20 pointsExhibit E: Development Set-Asides and Incentives 15 pointsExhibit F: Financial Information: 20 pointsTotal: 100 points


Harris County Request for ProposalsCommunity Development Block Grant (CDBG) Disaster Recovery Program Affordable Rental Housing Program

Monitoring ReviewsDue to federal requirements, Harris County will regularly monitor the construction phase of developments and annually uponlease-up. Upon funding of an awarded project, monitoring becomes an important component of the Grants Managementprocess. It is critical that Harris County and subrecipients maintain the appropriate documentation to support their activities inaccordance with federal guidelines and Harris County Community Services Department reporting requirements.

In conducting performance reviews, Harris County will primarily rely on information obtained from the subrecipient’sperformance reports, records from on site monitoring, and audit reports. Performance monitoring reviews typically result in aformal written report from Harris County summarizing the monitoring review and indicating whether or not the subrecipientwas found to be in compliance with all applicable regulations or requirements.

Due to federal requirements related to the expenditure of funds, Harris County will require monthly reporting for all publicservice projects. A regular review of expenditures will be conducted for public facilities, infrastructure and affordable housingprojects to ensure timely use of funds. Delays in the use of funds as compared with the submitted expenditure plan createtimeliness concerns that will result in the possible de-obligation of awarded funds.

RecordkeepingAccurate recordkeeping is crucial to the successful management of grant funded activities. Insufficient documentation willlikely lead to monitoring and findings. Please pay careful attention to guidelines outlined within the eligible activities section ofthe HCCSD website. If it is determined that the supporting documentation is incorrect or insufficient, reimbursement will bedenied for costs associated with the ineligible expense. Records must be retained for seven years after the grant closeout.Harris County staff and Federal and/or State funding partners or their authorized representatives have the right to accesssubrecipeint and contractor project records.

Access to RecordsHUD and the Comptroller General of the United States, or their authorized representatives, in addition to Harris County Staffhave the right to access Grantee and subrecipient program records.

HUD Section 3 / Minority and Women Business Enterprise (MWBE) ComplianceThe Section 3 program requires that recipients of certain HUD financial assistance provide training, employment, contracting and other economic opportunities to low- and very low-income persons, especially recipients of government assistance for housing, and to businesses that provide economic opportunities to low- and very low-income persons. Proposals demonstrating past experience with Section 3 are preferred.

Federal regulations also require that recipients should make every effort to use local business firms and contract with small, minority-owned and/or women-owned businesses in the procurement process. Specifically, recipients must take affirmative steps to use small firms, minority-owned firms, women-owned firms, or labor surplus area firms in CDBG-financed activities (24 CFR 85.36(e) or 84.44(b)). Proposals demonstrating past experience with MWBE requirements are preferred.

All applicants must pick one of two options:1) Comply with HUD Section 3 and MWBE requirements and complete a HCCSD Section 3 Employment & Minority Business Plan (to be downloaded from HCCSD's website with this application) to implement with their project; or2) Choose to pay up to 1% of requested HCCSD funding or $25,000 (whichever is lower) towards HCCSD's promotion of Section 3 activities in Harris County. Fee must be paid from none federal funds and is due at closing.


Applicant: Project:

Tab 1 Harris County Request for Proposal Cover Sheet (Offerors Note)

Application Checklist

Tab 2 Exhibit A: Applicant Information (5 points)

Attachment A-1: Damage Narrative and Documentation (if applicable)

Attachment A-2: Project Service Area Map

Attachment A-3: Project Legal Description

Tab 3 Exhibit B: Organizational Information (20 Points)Attachment B-1: Articles of Incorporation

Attachment B-2: 501(c)(3) Documentation (If applicable)

Attachment B-3: Agency’s Organizational Charts

Attachment B-4: Project Organizational Chart

Attachment B-5: Job Descriptions

Attachment B-6: Resumes of Key Personnel

Attachment B-7: Anti-Discrimination Policy

Attachment B-8: Declaration of Principal Owners, Officers & Directors

Attachment B-9: Letters of Funding Commitment

Attachment B-10: 120 Day Working Capital Documentation

Attachment B-11: Ownership Organizations and Principal Persons

Attachment B-12: Conflict of Interest Questionnaire/Local Government Officer

Tab 4 Exhibit C: Project Information (30 Points)Attachment C-1: Site Control Documentation

Attachment C-2: Completed Appraisal

Attachment C-3: Completed Survey

Attachment C-4: Relocation Plan (If applicable)

Attachment C-5: Environmental Requirements

Attachment C-6: Contractor Agreement & Procurement Activities

Attachment C-7: Design Plans

Attachment C-8: Site Plans

Attachment C-9: Cost Estimates

Attachment C-10: Market Survey/Analysis

Attachment C-11: Evidence of Notification to all Neighborhood Organizations

Attachment C-12: Evidence of Letters of Support from the CommunityAttachment C-13: Notices & Meeting Minutes (If applicable)Attachment C-14: Project Rent Roll (If applicable)

Tab 5 Exhibit D: Project Compliance and Scope of Services (20 Points)Attachment D-1: Relavent Development Information Checklist

Attachment D-2: Affirmative Marketing Plan

Attachment D-3: Policy and Procedures Manual

Tab 6

Tab 7 Exhibit F: Financial Information (20 points)

Entity-wide Financial Management & Systems QuestionnaireBudget Summary

Summary Sources & Uses of Funds

Construction Sources and Uses

Affordable Housing Development Cost

Pro-Forma (20 yr. Affordability Period)

Exhibit E: Development Set-Asides and Incentives (15 Points)

Rent Schedule

Attachment F-3: SF424D and Disclosure of Lobbying Activities

Attachment F-1: Audit/Financial Statements and IRS Form specified

Attachment F-2: Single Audit (If Applicable)

Conflict of Interest Statement (If applicable)


Application Checklist

Review the following list of documentation requirements. Three hard copies (one original and two copies) and an electronic copy of the Excel form (in addition to a PDF) and Phase 1 ESA on disc or flash drive are required for submittal. ALL hard copies submitted must include the following attachments in the stated order. Applications that do not will be considered INCOMPLETE.

HCCSD CDBG-DR RFP

Original PRIORITY 1 PRIORITY 3

Copy (If submitting more than one proposal, indicate the priority of this proposal.)

Exhibit A – Applicant Information (5 Points)Part 1- General Information

1. Type of Organization: Select entity type:2. Organization Legal Name:

3. Other/Former Names of Organization:

4. Project Name:

5. Mailing Address: City, State, and Zip Code:

6. Physical Address of Project: City, State, and Zip Code:

7. HCAD Parcel #:

8. Telephone:

10. Tax ID: 11. DUNS Number:

12. In which County Commissioner Precinct is your project located?

13.Are there any other significant investors, partners, entities securing this project?

YES NO

Signature of Authorized Person Listed Above DATE

Print Name DATE

Authorized Contact Name: Phone:

I CERTIFY THAT I AM AUTHORIZED TO REPRESENT THE ABOVE NOTED ORGANIZATION AND THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT AND THAT IT CONTAINS NO FALSIFICATIONS, MISREPRESENTATIONS, INTENTIONAL OMISSIONS, OR CONCEALMENT OF MATERIAL FACTS. I FURTHER CERTIFY THAT NO CONTRACTS HAVE BEEN AWARDED, FUNDS COMMITTED OR CONSTRUCTION BEGUN ON THE PROPOSED PROJECT AND THAT NONE WILL BE DONE PRIOR TO ISSUANCE OF A RELEASE OF FUNDS BY HARRIS COUNTY.

Email:

Person authorized to sign contracts.

Title:

Application Contact Name: Phone: Email:

Person writing this application.

Title:

Finance Contact Name: Phone: Email:

Person able to provide budget information.

Title:

Provide the following information:

Are you a CHDO?

Program Contact Name: Phone: Email:

Person managing the project on a daily basis

Title:

9. Fax:


CDBG-DR Affordable Rental Housing ProgramApplication

PRIORITY 2

Page A14

Part 2 - Application Technical Assistance

In completing this application, has the applicant received technical assistance from HCCSDstaff?

Part 3 - Program Funding

Part 4 - Project Description

Example: ABC Agency will construct 40 single family homes at 1000 Main Street for families at or below 80% AMI .

NOTE: For Multi-family projects, Harris County has included a minimum of $120,000 for construction management services to be procured by the applicant.

*HCCSD will not consider applications for projects requesting greater than 80% of total project funding.

A. Provide a brief description of the proposed project in the space below. The description should be no more than five sentences and describe the project (not the organization).

B. Identify the project location. Provide maps of the project location and the project service area as an attachment to this application as Attachment A-2. Include information on which high or low opportunity area the project is located or if the area has a comprehensive revitalization plan that sets forth a goal of increasing affordable housing and where Harris County has made significant investments in infrastructure/public facilities.. Do not submit the Harris County service area map as your project area map.

C. Please provide property legal description as Attachment A-3. Acceptable documentation includes legal description provided from title companies, surveyor or appraisals.

3) Total Project Cost 120,000 4) Percentage of Harris County funds *

100.00%

Yes No

1) Request Amount 120,000 2) Other Funding Source -


Page A15

Located in a high opportunity area

Yes No

F.Yes No N/A

Yes No N/A

Was FEMA contacted regarding project eligibility? (If Yes, complete all of F)

If FEMA was contacted, please provide FEMA's response. (Attach all relevant documentation)

If the project was eligible, were FEMA funds committed/received for the project?

Located in HCCSD Target Area with a community plan or an area of significant funding contribution into infrastructure or public facilities

None of the above

If Yes, complete sections F and G below and briefly explain what flooding damage or impacts occurred? Provide a brief narrative stating the cause of the damage below. Photos, other damage documentation, and FEMA/insurance documentation should be included as Attachment A-1. Damage claims must have proof of impact from Hurricane Harvey.

E. Was the proposed project damaged or impacted by Hurricane Harvey flooding during the time period of August 23, 2017 through September 15, 2017 (FEMA DR-4332)?

D. Is the project located in an area of high opportunity, High Priority Area or HCCSD Target Area (see maps at http://www.csd.hctx.net/serviceareamaps.aspx) with a community plan or area of revitalization where Harris County has made a significant funding contribution into infrastructure or public facilities?


Page A16

G. Yes No N/A

Did the applicant file a claim with the insurance company?Yes No N/A

Yes No N/A

Yes No N/A

What other state and/or federal agencies has the applicant contacted concerning funding for this project and what were the results?

Describe the impact of taking no action:

The situation addressed in this application first occurred? (Provide date)

Are local or other funds available to completely address the issue instead of CDBG-DR funds?

Was there a deductible?

If Yes, how much was the deductible?

If the applicant had coverage and a claim was not filed, why was a claim not filed?

Did the applicant have insurance coverage on the proposed project? (If Yes, complete all of G)

What was the name of the insurance company?

What was the amount of coverage?

Amount of insurance proceeds received or anticipated from the insurance company?

If FEMA funds were received, please provide the amount received, explain why funds are needed above and beyong FEMA funds and include a copy of the project worksheet.


Page A17

Exhibit B: Organizational Information (20 Points)Part 1 - Organizational Experience

Provide an organizational overview of your agency, including:A. A description of the history and purpose of the organization

B. Is the organization applying for funding incorporated? YesIf so, what year was the organization incorporated?

As a requirement of this application, please submit copies of your Articles of Incorporation as Attachment B-1.

If organization is a non-profit, please attach 501 (c )(3) documentation from theIRS as Attachment B-2.

C.

D. Provide the project organizational chart as Attachment B-4.

E.


NoMM/DD/YEAR

Provide the agency’s organizational chart and list of any significant investors and/or partners, including contact information as Attachment B-3.

List staff members who will be working directly or indirectly with the project. This information should match the information included on both the agency organizational and project organizational charts. Provide job descriptions as Attachment B-5 and resumes as Attachment B-6 for the persons listed below. Also complete Attachment B-11 for project ownership/special interest organizations and prinicipal persons.

Name and Title Years and Type of Relevant

Program Experience

Years and Type of Relevant Federal

Experience

No. of Years with Proposing

Organization

Page B18

Yes No

Yes No

Yes No

Yes

Part 2 – Board of Directors

1. Are you involved in any legal claim or lawsuit? Yes NoYes No

3. Do you have any outstanding judgments? Yes NoYes No

A.

If No, will on be developed and utilized for the proposed project?

G. Does the organization have annual training for staff and volunteers on compliance with HUD's Equal Access to Housing Final Rule and Fair Housing?

Declaration of Principal Owners, Officers & Directors (All applicants)

Please answer the following questions as they may apply to the applicant entity, each officer, each director and each owner of 20% or more of the applicant entity. For each "yes' answer, attach a separate signed exhibit as Attachment B-8 providing a detailed explanation.

2. Have you been involved in a bankruptcy or insolvency proceeding?

4. Have you ever had property foreclosed upon or given title or deed in lieu of foreclosure?

Please describe the criteria used to initially evaluate your Board of Directors, i.e. background checks, credit checks, resumes. As attachment B-8 please provide a list of your Board Members including the company affiliation, occupation/area of expertise and term (beginning years and ending years). *Not applicable for local governments.

H. How many years of experience does the organization have complying with HUD Section 3 guidelines for low and very-low income persons?

I. How many years of experience does the organization have complying with Minority Women Business Enterprise (MWBE) requirements?

F. Does the organization have an anti-discrimination policy? (Include as Attachment B-7)


J. Is the organization submitting a HCCSD Section 3 Employment & Minority Business Plan?

No (If no, applicant must pay Section 3/MWBE activities promotion fee, if awarded, at closing. See QRG p. 9 for details )

Page B19

Part 3 – Definition of Identity of Interest

All Applicants

A.

B.

C.

Signature of Authorized Agency Official Date

Typed Name and Title and Organization Name

When any of the parties is involved with another in an enterprise wholly separate from the proposed HOME/CDBG project.

A disclosure of the nature of any perceived or actual identity of interest must be made prior to applying for federal funds. Describe the nature of the interest below and identify the individual, partners or corporations party to any transaction. If there are no existing identity of interest please indicate N/A below.

When the seller or general contractor advances any funds to the owner(purchaser) or takes stock or any interest in the owner's (purchaser's) corporation, partnership, or property as payment.


Identity of interest means any relationship (generally based on family ties or financial interests) between (a) the seller and purchaser (prospective owner), (b) the owner and/or general contractor and the subcontractor, material supplier or equipment lessor, or (c) the owner and the lender, which could reasonably give rise to a presumption that the parties to the transaction may operate in collusion in establishing the purchase price of the property, the cost of the rehabilitation work, or the terms of the financing. Examples of identity of interest relationships include:

When the owner or one or more of the officers, directors, stockholders, or partners of a corporation or partnership owning or selling the property has any family tie or is an officer, director, stockholder or partner of the general contractor or lender, or has any financial interest whatsoever in the general contractor or lender.

Page B20

Part 4 – Conflict of Interest Disclosure

All Applicants

I certify that no conflict of interest exists between Harris County and

I certify that no conflict of interest exists between the subcontractors or employees of and

IF A CONFLICT EXISTS, COMPLETE THE FOLLOWING:

I certify that a conflict of interest may exist between Harris County and

I certify that a conflict of interest may exist between and

Signature of Authorized Agency Official Date

Typed Name and Title

(name of organization) (name of subcontractor/or employee)

Describe the nature of the conflict of interest below. Identify the individual, employment and the conflict or potential conflict, and their affiliation with your organization. Also, complete Tab3-Conflict of Interest.

(name of organization)


The standards in OMB Super Circular (2 C.F.R. 200.112 Conflict of Interest - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards) provide that no employee, officer, or agent shall participate in the selection, award, or administration of a contract supported by Federal funds if a real or apparent conflict of interest would be involved. Such a conflict would arise when an employee, officer, or agent, any member of his or her immediate family, his or her partner, or an organization which employs or is about to employ any of the parties indicated herein, has a financial or other interest in the firm selected for an award.

The CDBG regulations at 24 CFR 570.611, ESG regulations at 24 CFR 576.404, and HOME regulations at 24 CFR 92.356 provide that no person who is an employee, agent, consultant, officer, or elected official or appointed official of the recipient or subrecipient that are receiving CDBG, ESG or HOME funds and (1) who exercises or has exercised any functions or responsibilities with respect to activities assisted with such funds; or (2) who is in a position to participate in a decision-making process or gain inside information with regard to these activities, may obtain a financial interest from a CDBG-assisted, ESG-assisted or HOME-assisted activity, or have any interest in any contract, subcontract, or agreement with respect thereto, or the proceeds there under, either for themselves or those with whom they have family or business ties, during their tenure or for one (1) year thereafter.

A disclosure of the nature of any perceived or actual conflict must be made prior to the execution of agreements utilizing CDBG, ESG or HOME funds.

IF NO CONFLICT EXISTS, COMPLETE THE FOLLOWING:



Page B21

Part 5 – Leverage and Working Capital

A.

B.

Cash in Bank (provide 3 most recent bank statements or audited financial statements)Line of Credit (provide a letter on financial institution letterhead stating line of credit amount)Acct. Recv. Collection (provide recent audit, current balance sheet and evidence of validity)Liquidation of Securities, CD or Investments (provide copy of recent brokerage or CDstatement)Thrift shop proceeds as documented in IRS 990 or 990-T forms.Other - Please explain below and provide appropriate supporting documentation

Comments:

CDBG-DR program guidelines require applicants to meet a 20% leverage requirement. For each funding source listed in the budget forms, attach a letter of funding commitment (dated no later than 6 months prior to the application) as Attachment B-9.

All organizations must have 120-days working capital to ensure operational liquidity while awaiting reimbursement. Select one of the eligible sources of working capital listed below and attach supporting documentation as Attachment B-10. If necessary, provide detailed explanation below.


Page B22

CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity OFFICE USE ONLY

This questionnaire is being filed in accordance with chapter 176 of the Local Date Received

Government Code by a person doing business with the governmental entity.

By Law this questionnaire must be filed with the records administrator of the

local government not later than the 7th business day after the date the person

becomes aware of facts that require the statement to be filed. See Section

176.006, Local Government Code.

A person commits an offense if the person violates Section 176.006, Local

Government Code. An offense under this section is a Class C misdemeanor.

1. Name of person doing business with local governmental entity.

2.

Check this box if you are filing an update to a previously filed questionnaire.

3. Describe each affiliation or business relationship with an employee or contractor of the local

governmental entity who makes recommendations to a local government officer of the local

governmental entity with respect to expenditure of money.

4. Describe each affiliation or business relationship with a person who is a local government

officer and who appoints or employs a local government officer of the local governmental

entity that is the subject of this questionnaire.


Part 6 – Conflict of Interest Disclosure (If applicable attach as Attachment B-12)

FORM CIQ

(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year for which an activity described in Section 176.006(a), Local Government Code, is pending and not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)

HCCSD CDBG-DR RFPAttachment B-10:23

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor or other person doing business with local governmental entity

5. Name of local government officer with whom filer has affiliation or business relationship.

(Complete this section only if the answer to A, B, or C is YES.)

This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has

affiliation or business relationship. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? Yes No

B. Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the local government officer named in this section AND the taxable income is not from the local governmental entity? Yes No

C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? Yes No

D. Describe each affiliation or business relationship.

6. Describe any other affiliation or business relationship that might cause a conflict of interest.

7.

Signature of person doing business with the governmental entity Date


FORM CIQ

Page 2


LOCAL GOVERNMENT OFFICERCONFLICTS DISCLOSURE STATEMENT

OFFICE USE ONLY

Date Received

1. Name of Local Governmental Officer

2. Office Held

3. Name of person described by Sections 176.002(a) and 176.003(a), Local Government Code

4. Description of the nature and extent of employment or business relationship with person named in Item 3

5. List gifts if aggregate value of the gifts received from person named in item 3 exceeds $250

Date Gift Received Description of Gift Did Not Accept Gift



6. AFFIDAVIT

AFFIX NOTARY STAMP/SEAL ABOVE

, this the day of

,20 , to certify which, witness my hand and seal of office.

Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath

I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to a family member (as defined by Section 176.001(2), Local Government Code) of a government officer. I also acknowledge the statement covers the 12-month period described by Section 176.003(a)(2)(b), Local Government Code.

Signature of Local Government Officer

Sworn to and subscribed before me, by the said


FORM CIS

This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with chapter 176, Local Government Code.


Exhibit C – Project Information (30 Points)

Part 1 – Supplemental Action Plan Guidelines

A.

Housing (Renters)

B. Population to be Served (select all that apply)Disabled FamiliesHomeless HIV / AIDSSingle, Non-ElderlyElderly

Part 2 – Activity Type

A. Please select the activity type that best relates to your project.Acquisition only (Rent Roll Required*) Acquisition & Rehab (Rent Roll Required*)New Construction onlyRehabilitation Only (Rent Roll Required*)Acquisition of property and new construction

B. Do you have site control? Yes (Please attach a copy of supporting documentation as Attachment C-1)

No - HCCSD will not consider applications for projects without site control.

C. Do you have a completed property appraisal? Cannot be older than 6 months.Yes (Please attach a copy as Attachment C-2*) No, but will be available within 30 days. Please note that HCCSD will not send reminders.

D. Do you have a completed property survey?Yes (Please attach a copy of supporting documentation as Attachment C-3) No, but will be available within 30 days. Please note that HCCSD will not send reminders

E. Does your project involve:Major rehabilitation?* Yes NoMinor rehabilitation? Yes No

*Provide Rent Roll using the guidance provided as Attachment C-14 .


Rehabilitation/Reconstruction of Multi-family Housing

Please refer to the Supplemental Action Plan for CDBG-DR Round One Funding and select the project type that applies to your proposed project.

New Construction of Multi-family HousingAcquisition and/or Rehabilitation of Multi-family Housing

Page C26

G. If project involves the acquisition, rehabilitation, renovation, or conversion of a physical structure, provide the date the structure was constructed:

H. Will your project involve temporary or permanent relocation of residents or businesses? Yes No

relocation costs.

I.Yes No N/A

Part 3- Environmental Requirements

Have you had a Phase 1: Environmental Site Assessment (ESA) completed within the past year?Yes, submit Phase 1 as Attachment C-5

1) Site soils, vegetation and drainage characteristics.2) Chain of title review.3) Site and surrounding land use details and history.4) Historical aerial photograph and/or other newspaper review.5) Wetlands, floodplains and other natural features.6) Proximity to landfills, leaking storage tanks, airports etc.7) Environmental records searches with sources and citations.8) Recognized environmental conditions (RECs) posing any liability.9) Pictures of site.

A.Yes No


Will your project comply with the current zoning designation for the property?

Is the project located within the 100-year floodplain?

No. For any acquisition, rehabilitation or construction project, please attach the following information as Attachment C-5:

Note: if a Phase 1 ESA was not obtained for the subject site within 6 months prior to the project proposal submission date, Harris County will require a Phase 1 ESA within 30 days of the award of funds. For more information about the Phase 1 ESA, please see: ASTM E1527-05 Standard Practice for Environmental Site Assessments: Phase 1 Environmental Site Assessment Process, http://www.astm.org/Standards/E1527.htm

If Yes, a waiver is required. Provide waiver justification and what steps will be taken to mitigate.

*Major rehabilitation is defined as rehabilitation that involves costs in excess of 75 percent of the value of the building before rehabilitation. The value of the building means the monetary value assigned to a building by an independent real estate appraiser, or as otherwise established by the grantee or the State recipient.

If yes, provide the full relocation plan as Attachment C-4, and make sure budget reflects

Page C27

Part 4- Development Team – All Construction/Development Projects

A.

Consultant

B. Does the organization have a general contractor (must be bonded) selected to complete the project?

No (Please plan on reviewing all procurement policies with HCCSD prior to selecting a contractor)

No (Please plan on reviewing all procurement policies with contractor)N/A , explain:

C. Is Schematic Design or a more complete level of plans available? This must at minumum include front, rear, and side elevations of buildings as well the detailed unit floor plan for each bedroom size.

Yes (Attach supporting documentation as Attachment C-7) No (HCCSD may terminate application for consideration if unavailable)


D. Is a site plan available? Must show how project is to be built, indicating placement of buildings, parking areas, sidewalks, planned landscaping, amenities, easements, etc.

Yes (Attach supporting documentation as Attachment C-8) No (HCCSD may terminate application for consideration if unavailable)


E. Are project cost estimates available?Yes (Attach supporting documentation from engineer or architect as Attachment C-9) No (HCCSD may terminate application for consideration if unavailable)



Yes (Attach contractor agreement and detailed procurement summary as Attachment C-6)

Cost Estimator

Other

Property Manager

Tax Syndicator

General Contractor/ Builder

Architect

General Partner(s)

Limited Partner(s)

Developer

Owner

Please complete Development Team information by providing name, role and contact information.Position on

Development TeamPartner Agency and

Contact Person Phone and Email/ Web Site

Page C28

Part 5- Rental Construction/Development Projects

A.Multi-unit Rental Single-family Detached Rental Townhome Rental

0 0 00 0 00 0 00 0 00 0 00 0 0

B. CDBG-DR assisted units will be designated “Floating” units unless otherwise specified by HCCSD.*

C.

Yes No N/A

Yes No

Existing Low Income Use Restrictions or Existing Subsidies on Housing Acquisition/Rehabilitation ActivitiesIs the existing property subject to low-income use restrictions or receiving subsidies from a local, state or federal source?

If Yes, will the continued operation of this property with low-income use restrictions be placed at rist without the award of requested funds?


Note: CDBG-assisted units must be 51% of all units, comparable and distributed through out every unit type.

*A project may also receive HOME funding. If so, HCCSD will designate HOME-assisted units as “fixed”, the specific units that are HOME-assisted are designated and never change. CDBG-DR units may remain as "floating", overlaid with HOME-assisted units or be designated as "fixed" by HCCSD. Each project will be evaluated on a case-by-case basis if applicable.

If Yes, to either question above in Part 5, C., then attach a thorough description of the restrictions or subsidies with the other attachments of this section. At a minimum, describe the source, terms, length of restriction period and explain how the award of CDBG-DR funds will help preserve the unit afforability.

Total Project Units 0

3 04 0

1 02 0

5 or more 0

0 0

In the chart below, indicate the breakdown between CDBG-DR-assisted, LIHTC/bond, or other affordable units and market rate units. The chart will automatically calculate the number of units assigned to High HOME, Low HOME and rents for those that will serve households at 30% AMFI or below. Low HOME rents apply to households in the 31%-50% AMFI range and High HOME to 51% to 80% AMFI households. Bedroom Number

# of units

Market LIHTCOther

Affordable Units

CDBG-DR assisted

High HOME Rents

Low HOME Rents

30% AMFI and Below Rents (60%

of Low HOME)

What type of rental project is being proposed?

Page C29

Part 6 – Problem Statement

A.

●

●

●


Resulting need within the community- Based on market condition discuss the need for the proposed project. Discuss the market capture of the project.

Significance of project to the beneficiaries- How will the proposal project benefit beneficiaries? What amenities will the project have access to or is near to support its beneficiaries?

Develop a need statement that clearly states the purpose for the project. Discuss the causes of the problem, the resulting need within the community, and the significance of the project to the beneficiaries of the community. Support your statement with the market survey or market analysis as Attachment C-10.

Overview of the Market (Discuss market conditions, supply and demand, absorption rates, and vacancy rates in the targeted area for housing development. Also discuss the housing stock in surrounding neighborhoods (single family vs. multi; owner vs. renter).

Page C30

B. Neighborhood Notification and Public Hearing:

1. Did your organization provide written notification to all neighborhood organizations within a 2-mile radius of the development?

Yes (Please attach a copy of all notifications as Attachment C-11)No

2. Did your organization receive at least three (3) letters of support from the community in favor of the development, including one from the project's water/sewer provider?

(Water/sewer letter not required if property is located within the City of Houston)Yes (Please attach a copy of supporting documentation as Attachment C-12)No

3. For projects of 8 contiguous units or more: Did your organization hold a public hearing for the project? (Notices must have been sent at least two weeks in advance of the public hearing to all community groups within a 2-mile radius of the proposed project site)

Yes (Please attach copy of notices and meeting minutes as Attachment C-13)No, but a public hearing will be held on: N/A, project is less than 8 units

4. If your organization does not have community support, describe the measures your organization has taken to garner community support in the space below.


Page C31

Exhibit D – Project Compliance and Scope of Services (20 Points)

A.

Yes No

Did you complete the Relevant Development Information Checklist as Attachment D-1.Yes No

B. Affirmative Marketing and Fair Housing (All projects )

B.1 Commercial Media. (Check the type of media to be used to advertise the availability of this housing)Newspaper/Publications Other (please specify) Radio Television Billboards

B.2 Community Contacts

B.3 Experience and Training Staffa. Staff has experience affirmatively marketing an affordable housing program?

Yes Nob. List the primary staff member responsible for staff training related to the affirmative marketing plan:

To further inform the group(s) least likely to apply to this housing about its availability, the applicant agree to establish and maintain contact with groups/organizations listed below that are located in the service market area. If more space is needed attach an organizations if currently not available, maintain copies on the file.

Name of Group/Organization

Racial/Ethnic Identification

Approximate Date

(mm/dd/yyyy)Person Contacted or To

Be Contacted

Name of Newspaper, Radio or TV Station

Racial/Ethnic Identification of

Readers/Audience Size/

Duration of Advertising


Part 1 – Rental New Construction/Rehabilitation/Reconstruction Projects

Please reference the Harris County Community Services Department Affordable Housing Project Standards for development requirements. Do you agree to and does the proposed project comply with HCCSD’s Affordable Housing Project Standards? For additional guidance on the Affordable Housing Project Standards, please visit https://csd.harriscountytx.gov/Pages/rfq.aspx.

Please attach copy of Affirmative Marketing Plan as Attachment D-2. If you do not have a formalAffirmative Marketing Plan, describe the methods for informing the public, owners, and potentialtenants about Federal fair housing laws. Procedures to be used to inform and solicit applications forpersons in the housing marketing area who are not likely to apply for housing without special outreach.Recordkeeping details must describe actions to be taken to affirmatively market units and assess theresults of those actions. Please provide a copy of your Policy and Procedures Manual for the proposedproject as Attachment D-3 that demonstrates compliance with the Equal Access Housing Final Rule.

Page D32

C. Supportive Services and On-Site Activities

D. Transportation (Rental or Qualified Elderly Developments)

E. Maintenance Services (All projects) Provide a brief description of plan to ensure up keep of CDBG-DR assisted development.(Example: HOA, groundskeeper, reserve schedule etc.)

F.

Yes No (Application not eligible for this RFP)

G.

[1]Qualified Elderly Development-A Development which meets the requirements of the federal Fair Housing Act and: (A) is intended for, andsolely occupied by, individuals 62 years of age or older; or (B) is intended and operated for occupancy by at least one individual 55 years ofage or older per unit, where at least 80% of the total housing units are occupied by at least one individual who is 55 years of age or older; andwhere the Development Owner publishes and adheres to policies and procedures which demonstrate an intent by the owner and manager toprovide housing for individuals 55 years of age or older. (See 42 U.S.C. Section 3607(b)).

Per Exhibit C, Part 5, does your project involve the construction of 8 or more CDBG-DR-assisted residential units?

If yes, your organization will be required to comply with Federal prevailing wage requirements covered under the Davis Bacon and Related Acts.

Lead-Based Paint Compliance Please describe how your organization will address lead-based paint hazards associated with this project.


If development will have a supportive services component (example: on-site counseling, budgeting, self-sufficiency programs) please describe services and activities. Permanent supportive housing or transitional housing projects serving homeless population require the provision of supportive services and must be described below.

Provide a brief explanation of transportation services provided for project if applicable.Qualified Elderly Developments require specialized transportation services. Please describe transportation services for project.

Page D33

H. Energy Star Certification (All projects) Will this project meet Energy Star Certification?

Yes, project will meet requirementYes, project will exceed requirement

I.

Please describe how your project will meet and/or exceed the minimum standards stated in Harris County's Affordable Housing Standards (i.e. most recent version of ICC's International Building Code, Energy Star and elements of LEED.


How will the proposed development mitigate damage from a wide range of future disaster types and create a more resilient housing stock and community? Multi-family resiliency solutions include but are not limited to elevation; retention basins; fire-safe landscaping; firewalls; flood/mold resistant materials and landscaped floodwalls.

Page D34

A. What is the anticipated start date of your project?

B.

Total Expenditures $ -

Month:

Month:

Month:

Month:

Month:

Month:

Month:

Month:

Month:

Month:

Month:

Month:

Part 2 – Project Implementation

Production/Expenditure Schedule: Outline project activities as well as the proposed amount of CDBG-DR funds to be expended monthly during the contract period. This information will be used to structure the scope of services portion of the agreement.

Contract Period Project ActivitiesCDBG-DR Program

Expenditure


Month:

Month:

Month:

Month:

Month:

Month:

Page D35

A.

5 units - Minumum Required (no additional points)6 to 15 units - (1 point)15 to 50 units (2 points)

B. Accessible Units (ADA Standards and Section 504)

Minumum Number of Accessible Units (no additional points)2 to 5 additional Mobility and 1 to 2 additional Vision/Hearing units (2 points)6 or more Mobility and 3 or more Vision/Hearing units (3 points)

C.

No

NoYes (1 point)*

*NOTE: Projects that were damaged and claiming damage bonus points must complete Part E of Exhibit A and provide damage documentation information as Attachment A-1.

Harris County requires of a minimum of 5 percent of dwelling unitsbe accessible for persons with a mobility disability and an additional 2 percent must be accessible for persons with a hearing or visual disability. For new construction and major rehabilitation projects two addtional mobility accessible units and one additional accessible unit for a vision/hearing disability are required. The minimum can be exceeded and additional accessible units offered for additional points. Does the proposed development plan to offer more than the minimum number of accessible units?

Damage from Hurricane HarveyWas the proposed project damaged or impacted by Hurricane Harvey flooding during the time period of August 23, 2017 through September 15, 2017 (FEMA DR-4332)?

If Yes, is the proposed project rehabilitating or reconstructing units and/or buildings that were damaged by Hurricane Harvey?

Yes


Exhibit E – Develoment Set-Asides and Incentives (15 Points)

Supportive Housing Set-AsideHarris County has stated a minimum of 5 units are to be set-aside for clients/residents referred from the Coordinated Access System or other referral system approved by the County. Does the proposed development plan to offer more than the minimum set-aside of supportive housing units? If so, select the number of set-aside units to be provided.

Page E36

D.

Located in a high opportunity area (2 points)

E.

No

F. Exceeding Low-to-Moderate Income Requirement

No

G. Exceeding Minimum Leverage Requirement

No

H.

No

Is the project located in an area of high opportunity, High Priority Area or HCCSD Target Area (see maps at http://www.csd.hctx.net/serviceareamaps.aspx) with a community plan or area of revitalization where Harris County has made a significant funding contribution into infrastructure or public facilities? (Select only one)

Located in HCCSD Target Area with a completed community plan or an area of significant funding contribution into infrastructure or public facilities (2 points)

None of the above

Does the proposed development exceeds the 15 percent requirement of restricted units for families or individuals at 30 percent or less of area median family income?

Does the proposed development designate at least 70% of the units to serve low-to-moderate income families or individuals earning 80 percent of less area median family income as defined by HUD for the entire affordability period?


High Opportunity Zones

Yes (2 points)

Extremely Low-Income Targeting

Does the proposed development's total contribution of funding from other local, state, federal or private sources equal 50 percent or more of the total affordable housing development costs?

Yes (1 point)

Local Housing Authority PartnershipIs the proposed development the result of a partnership with a local housing authority in Harris County?

If Yes, provide proof of partnership (i.e. letter, MOU or other signed agreements)

Yes (2 points)

Yes (2 points)

Page E37

Exhibit F: Project Budget Information (20 Points)Part 1- Entity-wide Financial Management & Systems Questionnaire

YES NOACCOUNTING SYSTEM:

FINANCIAL CAPABILITY:

BUDGETARY CONTROLS:

1. Does your organization have and maintain a standard chart of accounts?

Harris County Request for ProposalsCommunity Development Block Grant (CDBG) Disaster Recovery Affordabel Rental Housing Program

A. Please describe your organization’s fiscal management practices & systems related to financial reporting, accounting systems, financial capacity, budgetary and internal controls and audit requirements by completing the Financial Management questionnaire.

FINANCIAL MANAGEMENT(QUESTIONNAIRE)

COMMENT

2. Does your accounting system include a project cost ledger that can be used for recording expenditures for “each” program by required budget cost categories?3. How do employees account for their time and effort? Please explain.

1. Does your organization prepare annual financial statements?2. Are those financial statements reviewed formally and approved/accepted by your Board or Officers?3. Are the financial statements subject to an annual Audit?4. Describe which basis of accounting your organization uses, e.g. (accrual, cash, or other) and what authoritative guidance your organization relies for accounting for general and grant funded activities.

5. Has the organization established line(s) of credit? If so, identify source and amount.

1. Are there budgetary controls in effect (e.g. comparison of budget with actual expenditures on a monthly basis) to preclude exceeding budgetary limitations?

2. Are all purchases made by PO whereby that encumbers/earmarks funds available for use?

3. Does someone in your organization periodically perform analysis and recommends/makes adjustments to budgetary spending levels due to identification of unforeseen or potential cash flow problems resulting from the analysis? If so, name the person(s)/

Page F38

INTERNAL CONTROLS

Part 2 – Financial Statements (Not Applicable to Harris County Departments)

A. Does organization have revenues in excess of $1,000,000? Select one.

Type of Entity:

Financial Documents Needed:

1. Are there written procedures for the following?

a. Accounting entries are supported by appropriate documentation; e.g. purchase orders and vouchers.separation of responsibility in the receipt, payment, and recording of cash.

c. Procedures for procurement and practices are consistent with applicable governing regulations.d. Travel is reviewed and approved and consistent with program guidelines and applicable to job functions.e. Timekeeping and payroll functions having segregation, proper review, approval, and support documentation of hours worked by activity and program.

f. Disclosures of Board, Officers or employees for related party transactions.2. Describe the safeguards your entity has instituted to ensure adequate internal controls in the company (e.g. Officially adopted policies and procedures, all expenses approved by board, documented and required annual review of policies).

Page F39

B. Did organization expend more than $750,000 in Federal funding during organization's fiscal year?Yes No

Date:

C. Financial Statement & Single Audits Findings

Harris County Request for ProposalsCommunity Development Block Grant (CDBG) Disaster Recovery Rental Housing Program

If yes, please attach as Attachment F-2, a copy of your required “single audit”. If your audit has not been completed, please note when this audit is to be completed.

If there were findings noted in either your most recent Financial Statement audit or Single Audit, please describe the nature of the findings and what steps your organization has taken to resolve the findings.

Page F40

DEVELOPMENT NAME (enter name of project):

Description

Harris CountyCDBG-DR

FundsHOME Match

CDBG-DR Leveraging TOTAL

Acquisition -$ -$ -$ -$

Off-Site -$ -$ -$ -$

Site -$ -$ -$ -$

Construction -$ -$ -$ -$

Other Construction -$ -$ -$ -$

General Soft Costs -$ -$ -$ -$

Construction Financing -$ -$ -$ -$

Permanent Financing -$ -$ -$ -$

Syndication -$ -$ -$ -$

Reserves -$ -$ -$ -$

Developer Fees -$ -$ -$ -$

Subtotal -$ -$ -$ -$

Harris County Required Services 120,000$ 120,000$

Subtotal 120,000$ -$ -$ 120,000$

TOTALS FOR HOME FUNDS REQUESTED: 120,000$ -$ -$ 120,000$

100% 0% 0% 100%

AFFORDABLE HOUSING DEVELOPMENT COSTS

BUDGET SUMMARY

CDBG-DR FUNDING

HCCSD CDBG-DRRental Housing RFP

Enter all of the Sources necessary to complete the project in the Yellow highlighted area below.

Source #

Funding DescriptionHarris County

CDBG-DR Funds25% Match

(HOME only) CDBG-DR 20%

LeveragingTotal Agency Source of Financing Status

1 Conventional Loan -$ 2 Conventional Loan/FHA -$ 3 Conventional Loan/Letter of Credit -$ 4 HOME/CDBG Funds 120,000$ 120,000$ 5 Housing Trust Fund -$ 6 Mortgage Revenue Bonds -$ 7 HTC Syndication Proceeds -$ 8 Historic Tax Credit Syndication Proceeds -$ 9 USDA/ TXRD Loan(s) -$ 10 Other Federal Loan or Grant -$ 11 Other State Loan or Grant -$ 12 Local Government Loan or Grant -$ 13 Private Loan or Grant -$ 14 Cash Equity -$ 15 In-Kind Equity/Deferred Developer Fee -$ 17 Other (specify): -$ 18 Other (specify): -$ 19 Other (specify): -$ 20 Other (specify): -$ 21 Other (specify): -$ 22 Other (specify): -$

TOTAL SOURCES OF FUNDS 120,000$ -$ -$ 120,000$

Use #

1 Acquisition -$ 2 Development Costs -$

3 Harris County Required Services 120,000$ 4 CHDO Operating -$ 5 Lead Hazard Controls Program -$ 6 Homebuyer Assistance Counseling -$

7 Supportive Services Costs -$

TOTAL USES OF FUNDS 120,000$

Summary Sources and Uses of Funds

Describe all sources of funds and total uses of funds. Information must be consistent with the information provided throughout the Application (i.e. Financing Participants and Development Cost Schedule forms). Where funds such as tax credits, loan guarantees, bonds are used, only the proceeds going into the development should be identified so that "sources" match "uses." Supporting Documentation for all listed sources must be supplied e.g.( bank committements, tax credit applications, syndication documents, etc...).

Applicants must describe the financing plan for the Development. This must include: (a) any non-traditional financing arrangements; (b) the use of funds with respect to the Development; (c) the funding sources for the Development including construction, permanent and bridge loans, rents, operating subsidies, and replacement reserves; and (d) the commitment status of the funding sources. Please note that HOME applicants must show a minimum of 25% match in the Yellow highlighted eligible categories. All "match" listed should be supported with documentation and should be eligible under the program's regulations.

Total Uses of Funds

Total Sources of FundsMust Equal ( = )


Enter all of the Sources necessary to complete the project in the Yellow highlighted area below.

Source # Funding Description

Harris County CDBG-DR

25% Match(HOME only)

CDBG-DR 20% Leveraging Total Agency Source of Financing for Construction Status

1 Construction Loan -$ -$ -$ -$ 2 Conventional Loan/FHA - 3 Conventional Loan/Letter of Credit - 4 HOME/CDBG Funds - Harris County Community Services Dept.5 Housing Trust Fund - 6 Mortgage Revenue Bonds -

7 HTC Syndication Proceeds (1st instalment) - [Agency] (Percentage of completion - only during construction up to 100% completion)

7 HTC Syndication Proceeds (2nd instalment) - [Agency] (Percentage of completion - only during construction up to 100% completion){if Applicable}

7 HTC Syndication Proceeds (3rd instalment) - [Agency] (Percentage of completion - only during construction up to 100% completion){if Applicable}

7 HTC Syndication Proceeds (4th instalment) - [Agency] (Percentage of completion - only during construction up to 100% completion){if Applicable}

7 HTC Syndication Proceeds (5th instalment) - [Agency] (Percentage of completion - only during construction up to 100% completion){if Applicable}

8 Historic Tax Credit Syndication Proceeds - 9 USDA/ TXRD Loan(s) - 10 Other Federal Loan or Grant - 11 Other State Loan or Grant - 12 Local Government Loan or Grant - 13 Private Loan or Grant - 14 Cash Equity - 15 In-Kind Equity/Deferred Developer Fee - 17 Other (specify): - 18 Other (specify): - 19 Other (specify): - 20 Other (specify): - 21 Other (specify): - 22 Other (specify): -

TOTAL SOURCES OF FUNDS -$ -$ -$ -$

Use #

1 Acquisition -$ 2 Development Costs -$

3 Harris County Required Services 120,000$

TOTAL USES OF FUNDS 120,000$

Summary Construction Sources and Uses of Funds

During the period of construction, describe all sources of financing (interim financing). Information must be consistent with the information provided throughout the Application (i.e. Financing Participants and Development Cost Schedule forms). Where funds, such as tax credits, loan guarantees, bonds are used, only the proceeds going into the development costs should be identified so that "sources" match "uses." Supporting Documentation for all listed sources must be supplied e.g.( bank commitments, tax credit applications, syndication documents, etc...). If sources of funds will be disbursed partially (like Syndication Proceeds) list only funds to be disbursed during construction - Disb 1- $$$$$$$; Disb 2- $$$$$$$; Disb 3-.... etc.

Applicants must describe the financing plan for the Development construction phase . This must include: (a) any non-traditional financing arrangements; (b) the use of funds with respect to the Development; (c) the funding sources for the Development including construction, bridge loans, rents, operating subsidies, and replacement reserves; and (d) the commitment status of the funding sources. Please note that HOME applicants must show a minimum of 25% match in the Yellow highlighted eligible categories. All "match" listed should be supported with documentation and should be eligible under the program's regulations.

Total Sources of FundsMust Equal ( = ) Total Uses of Funds

HCCSD CDBG-DR Rental Housing RFP

DEVELOPMENT NAME (enter name of project):

Number of Months for completion of the property acquisition phase, if applicable:

Number of Months for completion of construction/rehab phases:

The grid below is to be filled out for "RENTAL" Unit developments ONLY.

NUMBER OF AFFORDABLE UNITS SRO 0 BR 1 BR 2 BR 3 BR 4 BR TOTAL

30% OR BELOW OF HOUSEHOLD MEDIAN INCOME (15% of all units) 031 - 50% OF HOUSEHOLD MEDIAN INCOME (22% of all units) 051 -80% OF HOUSEHOLD MEDIAN INCOME (14% of all units) 0

TOTAL AFFORDABLE UNITS: 0 0 0 0 0 0 0MARKET RATE UNITS (Max 49%of all units) 0 0

TOTAL UNITS: 0 0 0 0 0 0 0

ENTER THE AVG SQ. FT / UNIT, BY UNIT TYPE 0

SRO 0 BR 1 BR 2 BR 3 BR 4 BR TOTAL2018 Low HOME Rent Limit -$ -$ -$ -$ -$ -$ -$

2018 High HOME Rent Limit -$ -$ -$ -$ -$ -$ -$

2018 TDHCA 30% and below AMFI (60% Low HOME) Rent Limit -$ -$ -$ -$ -$ -$

Fair Market Rent -$ -$ -$ -$ -$ -$ -$

12 Mo. Total RentTotal Potential Rent Income Based on Low HOME Limits -$ -$ -$ -$ -$ -$ -$

12 Mo. Total RentTotal Potential Rent Based on High HOME Limits -$ -$ -$ -$ -$ -$ -$

AFFORDABLE SQ FTG. 0 0 0 0 0 0

The grid below is to be filled out for MULTI FAMILY developments.

SRO 0 BR 1 BR 2 BR 3 BR 4 BR TOTALHOUSING UNIT TOTAL SQ FOOTAGE OF UNITS IN DEV: - - - - - - -

AFFORDABLE UNIT % OF SQ FT. 0.0%

MARKET UNIT % 0.0%

TOTAL SQ FT OF COMMON AREA FACILITIESSQ FOOTAGE FOR AFFORDABLE UNIT - COMMON AREA ASSOCIATED WITH AFFORDABLE UNITS - TOTAL SQ FT INCLUDING COMMON AREA - AFFORDABLE HSG. DEVELOPMENT: -

AFFORDABLE HOUSING DEVELOPMENT DETAIL

PART I - DEVELOPMENT DATA

For Affordable Housing Developments projects, please provide the following information in the yellow highlighted fields.

Potential Rental Income - 12 Months


Harris County CDBG-DR

HOME MatchCDBG-DR Leveraging

Total Project Cost

A

A1 Site Acquisition Cost (Land & Improvements) ['206©] -

A2 Existing Building Acquisition Costs -

A3 Appraisal ['206(d)(2)] -

A4 Title Examination ['206(d)(2)] -

A5 Legal, Recordation, etc. ['206(d)(2)] -

A6 Other (specify) -

A7 Total Acquisition Costs - - - -

B

B1 Off-site concrete -

B2 Storm drains & devices -

B3 Water & fire hydrants -

B4 Off-site utilities -

B5 Sewer lateral(s) -

B6 Off-site paving -

B7 Off-site electrical -

B8 Other (specify) -

B9 Subtotal Off-Site Costs - - - -

C

C1 Demolition -

C2 Rough grading -

C3 Fine grading -

C4 On-site concrete -

C5 On-site electrical -

C6 On-site paving -

C7 On-site utilities -

C8 Decorative masonry -

C9 Site Work, (Roads, Sewer and Water lines) -

C10 Bumper stops, striping & signs -

C11 Landscaping -

C12 Pool and decking -

C13 Athletic court(s), playground(s) -

C14 Fencing -

C15 Other (specify) -

C16 Subtotal Site Costs - - - -

SITE WORK

This form should be used to indicate how the requested funds would be generally budgeted for Homeownership and Rental Housing Projects . The regulatory references on each line are references to the HOME Program Regulations.

OFF-SITE

Line Item and Number

PART II - DEVELOPMENT COSTS

DETAIL OF PROPOSED PROJECT COSTS - AFFORDABILITY HOUSING ACTIVITIES

ACQUISITION COSTS


D

D1 Construction Costs

a Concrete -

b Masonry -

c Metals -

d Woods and Plastics -

e Thermal and Moisture Protection -

f Roof Covering -

g Doors and Windows -

h Finishes -

i Specialties -

j Equipment -

k Furnishings -

l Special Construction -

m Conveying Systems (Elevators) -

n Mechanical (HVAC; Plumbing) -

o Electrical -

D2 Lead-Based Paint Abatement -

D3 Asbestos Abatement -

D4 Furnishings -

D5 Utility Connections -

D6Common Laundry & Community Facility Rehab & Construction (cannot exceed allowable for affordable units %)

- 0%

Passed

D7 Other Common Area Rehab -

D8 Other (specify) -

D10 Subtotal Construction/Rehab Costs: - - - -

TOTAL SITE PLUS CONSTRUCTION/REHAB COSTS: - - - -

E

E1 General Requirements (see Program Guide for limits) <6% - 0.0% Test Passed

E2 Field supervision/job training program costs -

E3 Contractor Overhead < 2% - 0.0% Test Passed

E4 General and Administrative (within contractor overhead) -

E5 Contractor profit/fee (<6% limit) - 0.0% Test Passed

E6 Sum of E1 through E5: (may not exceed 14%) 0.0% Test Passed

E7 Construction Contingency - (s/b 5% if cost is > $1M) - 0.0%

E8 Subtotal "Other Direct" Construction & Rehab: - - - -

TOTAL CONSTRUCTION / REHAB CONSTRUCTION COSTS: - - - -

DIRECT CONSTRUCTION/REHAB COSTS

OTHER CONSTRUCTION COSTS


F

F1 Architect /Engineering Fees ['206(d)(1)] -

F2 Refinancing Fees [206(b)(1) & (2)], including HOME/CDBG loans -

F3 Financing Fees (i.e., Commitment) ['206(d)(2)] -

F4 Related Finance (Closing) Costs ['206(d)(2)] -

F5 Building Permits ['206(d)(2)] -

F6 Audit ['206(d)(3)] -

F7 Affirmative Marketing/Fair Housing ['206(d)(4)] -

F8 Impact Fees -

F9 Surveys -

F10 Appraisal -

F11 Market analysis -

F12 Environmental -

F13 Insurance -

F14 CHDO Project-Specific Costs (Loan only) ['301] -

F15 Relocation Costs ['206(f)] -

F16 Interim Financing Costs ['206(g)] -

F17 Other (specify) -

F18 Subtotal General Soft Costs - - - -

G

G1 Direct Construction & Rehab Costs (Financing):

G2 Financing - Construction Insurance -

G3 Construction - Loan Origination -

G4 Financing - Taxes during Construction -

G5 Financing - Construction Loan Origination Fee -

G6 Financing- Property Taxes During Construction -

G7 Other (specify) -

G8 Subtotal Construction Financing - - - -

H

H1 Credit Report -

H2 Permanent Loan Origination Fee -

H3 Title & Recording -

H4 Legal Fees -

H5 Documentation Fees -

H6 Escrow Closing Fees (INELIGIBLE EXPENSE) -

H7 Escrow Prepaids (INELIGIBLE EXPENSE) -

H8 Other Permanent Financing -

H9 Subtotal Permanent Financing - - - -

TOTAL FINANCING: - - - -

I

I1 Partnership Formation Costs -

I2 Bridge Loan Fees & Expenses -

I3 Tax / Bond Counsel Fees -

I4 Tax Credit Fees -

I5 Mtg Insurance Fees -

I6 Other Legal Fees -

I7 Consultant fees -

I8 Contractor & Developer Guarantee Fees -

I9 Other (specify) -

I10 Subtotal Syndication - - - -

GENERAL SOFT COSTS

CONSTRUCTION FINANCING

SYNDICATION COSTS

PERMANENT LOAN FINANCING COSTS


J

J1 Rent-up -

J2 Operating -

J3 Replacement -

J4 Escrow Prepaids (INELIGIBLE EXPENSE) -

J5 Subtotal Reserves - - - -

G

G1 Housing consultant fees -

G2 General & administrative -

G3 Profit or fee -

G4 Subtotal Developer's Fees: (sum of G1 through G3 can not exceed 15%) - - - -

TOTAL DEVELOPMENT & ACQUISITION COST BEFORE HCPID - - - -

E8HC Engineering Dept. Services - CSD and HCED inspections [206(d)(6)] (5% of funds invested):

- -

E9 Construction Manager [Fixed $120,000.00] 120,000 120,000

H TOTAL DEVELOPMENT COSTS 120,000 - - 120,000

100% 0% 0% 100%

Harris County Share

Match / Leverage

Other Sources/ Commitments

Total Project Cost

Per Unit $ Subsidy/investment related to Acquisition Costs: -$ -$ -$ -$ Per Unit $ Subsidy/investment related to Off Site Work: -$ -$ -$ -$ Per Unit $ Subsidy/investment related to "Site" work: -$ -$ -$ -$ Per Unit $ Subsidy/investment related to Constr/Rehab & Other Contractor: -$ -$ -$ -$ Per Unit $ Subsidy/investment related to General Soft Costs: -$ -$ -$ -$ Per Unit $ Subsidy/investment related to Financing Costs: -$ -$ -$ -$ Per Unit $ Subsidy/investment related to Syndication Costs: -$ -$ -$ -$ Per Unit $ Subsidy/Required Reserve Costs: -$ -$ -$ -$ Per Unit $ Subsidy/investment related to Developer Fees: -$ -$ -$ -$ Per Unit $ Subsidy/Required HCPID Costs: -$ -$ -$ -$ Total Unit Subsidy Per Unit: -$ -$ -$ -$

Per unit Subsidy Threshold-Rental Developments: 40,000$ PER UNIT SUBSIDY: N/A

0 0

A6 ACQUISITION

B8 OFF-SITE

C15 SITE WORK

D8 DIRECT CONSTRUCTION/REHAB COSTS

F17 OTHER GEN SOFT COSTS

G7 OTHER CONSTRUCTION FINANCING

H8 OTHER PERMANENT FINANCING

I9 OTHER SYNDICATION COSTS

F8 Other General Soft Costs

F10 Other General Soft Costs

RESERVES

DEVELOPER FEES

PART IIII DESCRIPTION OF "OTHER COSTS"


Pro-Forma Operating BudgetThis form should be reproduced to show projections for the entire affordability period.

Year 1 Year 2 Year 3 Year 4 Year 5 Year 10 Year 15 Year 20 Year 25 Year 30

Beginning CASH $ - $ - $ - $ - $ - $ - $ - $ - $ -

Operating Income Gross Rent Potential (a) -$ -$ -$ -$ -$ -$ -$ -$ -$ Vacancy Allowance (__% of line 1) -$ -$ -$ -$ -$ -$ -$ -$ -$ Effective Gross Rent -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ Other Income -$ -$ -$ -$ -$ -$ -$ -$ -$ Reserve for bad debt -$ -$ -$ -$ -$ -$ -$ -$ -$

Gross Income (GI) -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

Operating Expenses Management Fees -$ -$ -$ -$ -$ -$ -$ -$ -$ Management Staff Cost -$ -$ -$ -$ -$ -$ -$ -$ -$ Legal Fees -$ -$ -$ -$ -$ -$ -$ -$ -$ Accounting/Audit Fees -$ -$ -$ -$ -$ -$ -$ -$ -$ Advertising/Marketing -$ -$ -$ -$ -$ -$ -$ -$ -$ Telephone -$ -$ -$ -$ -$ -$ -$ -$ -$ Office Supplies -$ -$ -$ -$ -$ -$ -$ -$ -$ Other Administrative Expenses -$ -$ -$ -$ -$ -$ -$ -$ -$

Subtotal -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ Maintenance Maintenance Staff Cost -$ -$ -$ -$ -$ -$ -$ -$ -$ Elevator (if any) -$ -$ -$ -$ -$ -$ -$ -$ -$ Other Mechanical Equipment (specify) -$ -$ -$ -$ -$ -$ -$ -$ -$ Decorating (specify) -$ -$ -$ -$ -$ -$ -$ -$ -$ Routine Repairs and Supplies -$ -$ -$ -$ -$ -$ -$ -$ -$ Exterminating -$ -$ -$ -$ -$ -$ -$ -$ -$ Lawn and Landscaping -$ -$ -$ -$ -$ -$ -$ -$ -$ Garage/Trash Removal -$ -$ -$ -$ -$ -$ -$ -$ -$ Snow Removal -$ -$ -$ -$ -$ -$ -$ -$ -$ Other (specify) -$ -$ -$ -$ -$ -$ -$ -$ -$

Subtotal -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ Utilities Electricity -$ -$ -$ -$ -$ -$ -$ -$ -$ Residential -$ -$ -$ -$ -$ -$ -$ -$ -$ Commercial Areas -$ -$ -$ -$ -$ -$ -$ -$ -$ Common Areas -$ -$ -$ -$ -$ -$ -$ -$ -$ Heat and Hot Water (specify fuel) -$ -$ -$ -$ -$ -$ -$ -$ -$ Residential -$ -$ -$ -$ -$ -$ -$ -$ -$ Commercial Areas -$ -$ -$ -$ -$ -$ -$ -$ -$ Common Areas -$ -$ -$ -$ -$ -$ -$ -$ -$ Sewer and Water -$ -$ -$ -$ -$ -$ -$ -$ -$

Subtotal -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ Taxes/Insurance/Reserves Property Insurance -$ -$ -$ -$ -$ -$ -$ -$ -$ Real Estate Taxes -$ -$ -$ -$ -$ -$ -$ -$ -$ Annual Monitoring Fee - (Reserve) 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ Reserve Replacement -$ -$ -$ -$ -$ -$ -$ -$ -$ Operating Deficit Reserves -$ -$ -$ -$ -$ -$ -$ -$ -$

Subtotal 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ 150.00$ Total Operating Expenses (TOE) -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

Income Available for Debt ServiceEffective Gross Income (GI - TOE) -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

Non Operating Expenses:Debt Service -$ -$ -$ -$ -$ -$ -$ -$ -$ Debt Service Coverage Ratio Required - - - - - - - - - -

Ending Cash: -$ -$ -$ -$ -$ -$ -$ -$ -$ -$


Development Name: City:

HTC Unit Designation

CDBG-DR Unit Designation

HTF Unit Designation

MRB Unit Designation

Other Designation/

Subsidy# of Units

# of Bed-

rooms

# of Baths

Unit Size (Net

Rentable Sq. Ft.)

Total Net Rentable Sq.

Ft.

Program Rent Limit

Tenant Paid Utility

Allow.

Rent Collected

/Unit

Total Monthly Rent

(A) (B) (A) x (B) (E) (A) x (E)

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 0 -

Non Rental Income $0.00 per unit/month for:

Non Rental Income 0.00 per unit/month for:

Non Rental Income 0.00 per unit/month for:

+ TOTAL NONRENTAL INCOME $0.00 per unit/month -

-

- Provision for Vacancy & Collection Loss % of Potential Gross Income: 7.50% -

-

-

Rent Schedule (Required for All Rental Developments)Unit types should be entered from smallest to largest based on "# of Bedrooms"and "Unit Size", then within the same "# of Bedrooms" and "unit Size" from lowest to highest "Rental Income/Unit".

Type of Unit designation should be one or more of the following based on the unit's rent restrictions:Tax Credit: (TC30%), (TC40%), (TC50%), (TC60%), Employee Occupied (EO), Market Rate (MR), as allowed by Sec. 42.

501(c)(3) Mortgage Revenue Bond: (MRB), (MRB30%), (MRB40%), (MRB50%), (MRB60%), Market Rate(MRBMR).

= POTENTIAL GROSS MONTHLY INCOME

CDBG-DR: High (HH), Low (LH), 30% AMFI/60% Low HOME unit (LLH), Market Rate (MR)

Other: describe any "Other" rental assistance or rent restrictions in the space provided; documentation supporting the rentl assistance or restrictions must be provided

Housing Trust Fund : (HTF30%), (HTF40%), (HTF50%), (HTF60%), (HTF80%), Market Rate (MR)Units funded under more than one program, the "Program Rent Limit" should be the most restrictive - for example, a LH and TC60% unit would use the “LH” Program rent limit.

The rent and utility limits available at the time the Application Packet is submitted should be used to complete this form. Gross Rent cannot exceed the HUD maximum rent limits unless documentation of project-based rental assistance is provided. The unit mix and net rentable square footages must be consistent with the site plan and architectural drawings.

TOTAL

describe source here



- Rental Concessions

= EFFECTIVE GROSS MONTHLY INCOME

x 12 = EFFECTIVE GROSS ANNUAL INCOME

CDBG_DR_HC_Aff_Rental_Housing_Application_091118_Final_for_Web, Version Date: 3/1/2018TEXAS GENERAL LAND OFFICE – UNIFORM APPLICATION (ALL HOUSING DEVELOPMENT APPLICATIONS)

Rent Schedule (Cont.)

0 0

0 HOUSING 0

HOUSING 0 0

0 0

TAX 0 TRUST 0

0 0

CREDITS 0 0

0 FUND 0

0 0

0 0

0 0

MORTGAGE 0 CDBG-DR 0

0 0

REVENUE 0 0

0 0

BOND 0 0

0 OTHER 0

Populations Served

TC30% HTF30%

TC40% HTF40%

TC50% HTF50%

TC60% HTF60%

HTC LI Total HTF80%

TCEO HTF LI Total

MR MR

MR Total MR Total

TC Total HTF Total

MRB30% HOME HH

MRB40% HOME LH

MRB50% HOME LLH (60% Low HOME)

MRB60% HOME LI Total

MRB LI Total MR

MRBMR MR Total

MRBMR Total HOME Total

MRB Total Total OT Units

NOTE: a minimum of 5% plus 2 additional units of the total units must be designated for persons with disabilities and an additional 2% plus 1 additional units of the total units must be designated for the hearing/visually impaired.

CDBG_DR_HC_Aff_Rental_Housing_Application_091118_Final_for_Web, Version Date: 3/1/2018TEXAS GENERAL LAND OFFICE – UNIFORM APPLICATION (ALL HOUSING DEVELOPMENT APPLICATIONS)

Harris County Community Services Department Standards and Design Criteria

Schematic Design Phase

Shall include but not necessarily be limited to the following:

1. The Architect shall evaluate the County’s program and provided schedule and construction budget

requirements, each in terms of the other.

2. Attend preliminary conferences with the County regarding the Project, including preparation and

distribution of meeting notes to all concerned parties.

3. Visit the Project site to assess the impact of utility availability to the site (water, sewer, electrical

power and telephone). Apply for and receive utility data outlet statement from CenterPoint or other

electrical service provider.

4. Provide appropriate recommendations for the design of proper drainage and erosion control.

5. Provide soil and foundation (geotechnical testing) investigations or any special surveys and tests

which may be required for design.

6. When necessary, field-verify existing conditions, improvements and utilities for continuity or

coordination with the Project to be constructed.

7. Identify and secure all design and construction requirements for approval from all

governmental/utility agencies and departments having jurisdiction over this project, including but not

limited to: TPDES (See Number 7A and 7B below), TEXAS DEPARTMENT OF LICENSING AND REGULATION

(TDLR), HARRIS COUNTY FLOOD CONTROL DISTRICT, CITY OF HOUSTON OR LOCAL CITY, CENTER POINT

ENERGY, CORPS OF ENGINEERS, HARRIS COUNTY CENTRAL TECHNOLOGY. Provide contact person(s) and

telephone numbers from each agency.

a. SWPPP:

For projects that will disturb one acre or greater of land (or be part of a larger common plan of

development with the potential to disturb one acre or greater) the Architect shall include in

specifications, a Storm Water Pollution Prevention Plan that is in accordance with state and local

regulations. The SWPP shall include the necessary forms required in obtaining coverage under

the Texas Pollutant Discharge Elimination Attachment E: Standards and Design Criteria System

(TPDES) General Permit TXR150000 for storm water discharges associated with construction

activities.

b. SWQMP:

For projects meeting the definition of “new development” or “significant redevelopment” as

defined by the local storm water regulations and/or ordinances, the Architect shall develop a

Storm Water Quality Management Plan and procure a Storm Water Quality permit from the

local regulating authority prior to advertising for bids.

8. Based on the agreed upon program, schedule and construction budget, the Architect shall review with

the County a minimum of three (3) alternative approaches to design.

9. For those projects designated to seek LEED certification, the Architect shall provide the following:

a. Register project for LEED Certification with the US Green Build Council (USGBC).

b. Conduct a LEED design workshop with County representatives and the A/E team. Prepare

draft LEED score card with list of targeted LEED points.

c. Assist County with preparation of Owner’s Project Requirements (OPR).

d. Prepare draft Basis of Design (BOD).

10. The Architect shall prepare for approval by the County, electronic Schematic Design Documents

consisting of drawings and other documents illustrating the scale and relationship of Project

components in Adobe (pdf) format with mark-ups and comments enabled.

11. Architectural Design/Documentation responding to program requirements:

a. Site plan

b. Floor plans at 1/8 "= 1'-0" scale for each level

c. All elevations at 1/8" =1'-0" scale

d. Two or more building sections at 1/8" = 1'-0" scale

e. Outline specifications indicating major systems and material choices for the project

f. Other illustrative materials - renderings, models or drawings necessary to adequately present

the concept

g. All drawing sheets shall be 24" tall x 36" wide maximum or larger as approved by County

Engineer.

12. Structural Design/Documentation consisting of recommendations regarding basic structural

materials and systems, analyses, and development of conceptual design solutions for:

a. Preferred structural system and layout Attachment E: Standards and Design Criteria

b. Alternative structural systems

13. Mechanical Design/Documentation consisting of consideration of alternative materials, systems and

equipment, and development of conceptual design solutions for:

a. Energy Source(s)

b. Energy conservation

c. Heating and ventilating

d. Air Conditioning

e. Plumbing

f. Fire protection

g. General space requirements

14. Electrical Design/Documentation consisting of consideration of alternative systems,

recommendation regarding basic electrical materials, systems and equipment, analyses, and

development of conceptual design solutions for:

a. Power service and distribution

b. Lighting

c. Telephones

d. Computers

e. Fire detection and alarms

f. Security systems

g. Electronic communications

h. General space requirements

15. Civil Design/Documentation consisting of a consideration of alternative materials and systems and

development of conceptual design solutions for:

a. On-site utility systems

b. Off-site utility work

c. Fire protection systems

d. Drainage systems

e. Paving

f. Traffic flow, access, and impacts

16. Landscape Design/Documentation services consisting of consideration of alternative materials

systems and equipment and development of conceptual design solutions for land forms, lawns, and

plantings based on program requirements, physical site characteristics, design objectives and

environmental determinants.

17. Interior Design/Documentation services consisting of space allocation and utilization plans based on

functional relationships, consideration of alternative materials, systems and equipment and

development of conceptual design Attachment E: Standards and Design Criteria solutions for

architectural, mechanical, electrical and equipment requirements, in order to establish:

a. Partition layouts

b. Furniture and equipment layouts

18. Materials Research/Specifications consisting of:

a. Identification of potential architectural materials, systems, and equipment and their criteria

and quality standards consistent with the conceptual design.

b. Investigation of availability and suitability of alternative architectural materials, systems and

equipment.

c. Coordination of similar activities of other disciplines.

19. Project Development Scheduling consisting of reviewing and updating previously established project

schedules or initial development of project schedules (if not previously established), for decision-

making, design, documentation, contracting and construction.

20. Presentation consisting of Schematic Design Documents by the Architect to the appropriate client

representatives.

21. Obtain approval of the Schematic design from the County. The final schematic design documents will

have a signature and date title block and Design Development Phase Services shall not commence until

signature(s) of the County’s duly authorized representative(s) are affixed to the documents and written

authorization to proceed by the County Engineer is received by the Architect. Architect and consultant(s)

shall include name of responsible Architect or Engineer responsible for each sheet with registration

number and “interim review” stamp or note affixed.

Harris County CDBG-DR Affordable Rental Housing RFP Attachment B-11

LIST OF ORGANIZATIONS WITH AN OWNERSHIP OR SPECIAL INTEREST IN THE

APPLICANT Provide the requested information for all partnerships, corporations, limited liability companies, trusts, or any other public or private entity and their Affiliates1 that will have an ownership interest in or that will exercise control over the Applicant. Organizations that own or control other organizations should also be identified until the only remaining sub-entity would be natural persons. However, if the Applicant is directly owned or controlled by a person or persons, then the individual’s information should be provided below and in the “List of Principals of Organizations with an Ownership or Special Interest in the Applicant” form. Organizations that are Developers and/or guarantors must also be listed on this form as must any organization (and natural person whose ownership interest in an applicable entity is direct instead of via membership in an organization) that will receive more than 10% of the developer fee.

Organization Legal Name: Contact Name: Address: City: State: ZIP: Phone: ( ) - Fax: ( ) - Email: Name(s) and Ownership % of Entities the Organization Owns or Controls: % Is Organization legally formed? Yes No Date of formation: Legal Form of Organization is or will be (mark all that apply):

For-profit Corporation Nonprofit Corporation General Partnership Limited Partnership Limited Liability Company Unit of Local Government Housing Authority Individual/DBA

Other Designations (mark all that apply): Historically Underutilized Business Federal Tax Exemption Community Housing Development Org.







Additional pages of this form can be found at the “2009 Additional Forms” link on the Department’s website.

1 Affiliate – An individual, corporation, partnership, joint venture, limited liability company, trust, estate, association, cooperative or other organization or entity of any nature whatsoever that directly, or indirectly through one or more intermediaries, Controls, is Controlled by, or is under common Control with any other Person, and specifically shall include parents or subsidiaries. Affiliates also include General Partners, Special Limited Partners and Principals with an ownership interest.

Harris County CDBG-DR Affordable Rental Housing RFP Attachment B-11

LIST OF PRINCIPALS OF ORGANIZATIONS WITH AN OWNERSHIP OR SPECIAL INTEREST IN

THE APPLICANT This form must include all organizations and natural persons with an ownership interest in the Development Owner, Developer, or Guarantor or that will receive more then 10% of the developer fee. This form must also include the executive directors and board members of nonprofits, corporations and government instrumentalities (even if the executives and board members own “0%” of the organization.)

Organization Name: Principal Name: Role/Title

% I

nter

est

in th

e O

rg. Principal has

Previous Participation with Funding from GLO:

Organization 1.1 (Blank if space to left is not blank) Development Owner 100% Yes No Principal 1 General Partner 100% Yes No Organization 1.2 (the GP, e.g. a non profit) (Blank if space to left is not blank) General Partner 100% Yes No Principal 1 Executive Director 0% Yes No Principal 2 Board Member 0% Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No

If another page is required, complete an additional page to include after this one.

Harris County CDBG-DR Affordable Rental Housing RFP Attachment C-14

Rent Roll Information (Acquisition and/or Rehabilitation Projects Only)

For acquisition and/or rehabilitation of rental developments, a current rent roll is required. The rent roll must be dated not more than six months prior to the first day of the Application Acceptance Period. It should generally disclose the terms and rate of all leases and holdovers as of the date of the rent role. At a minimum, it should include: the unit number, the unit type (number of bedrooms, baths and size of the unit), the tenant’s name if occupied or “vacant” if not occupied, date current tenant moved in or, if vacant, the date the last tenant moved out, date of lease expiration, the monthly rent amount stated on the lease, the monthly rent amount paid by the tenant (i.e. net of concessions or subsidy). The following example form is available from Harris County. However, the required information does not need to be re-entered on the example form below if the current owners/property manager’s existing roll contains this information.

SAMPLE RENT ROLL Date: Completed

By: As of

Date:

Unit #

Unit Type/ Sq. Ft.

Tenant Name

Lease Start

Lease Expiration

Rental Rate

Tenant Pays

Comments

101 1/1-630 Jones 10/08 10/10 450 450 102 1/1-630 Smith 12/08 12/10 450 400 103 1/1-690 Travis 6/07 6/09 470 470 104 2/1-720 Wright 5/07 5/09 600 450 105 2/1-720 Vacant 10/07 10/09 600 0 106 2/1-790 Johnson 11/07 11/09 650 650

Harris County CDBG-DR Affordable Rental Housing RFP Attachment D-1

Relevant Development Information Checklist

Building/Unit Configuration:

Maximum # Floors:

Elevator-Served: No Yes Total Site Acreage:

# Res. Buildings: # of Non-Res. Buildings:

Unit Amenities and Quality. Select All That Apply:

Covered entries Nine-foot ceilings Microwave ovens Self-cleaning ovens Ceiling fixtures in all rooms Refrigerator with icemaker Laundry connections Storage room Laundry equipment (washers and dryers) in each individual unit Thirty-year architectural shingle roofing Covered patios/balconies Covered parking 100% masonry on exterior Greater than 75% masonry Use of energy efficient alternative construction materials R-15 Walls / R-30 Ceilings (rating of wall system) 14 SEER HVAC air conditioners, evaporative coolers, or radiant barrier in the attics High Speed Internet service to all Units at no cost to residents Fire Sprinklers in all Units

Common Amenities. Select All That Apply:

Full perimeter fencing Controlled gate access Gazebo with sitting area Accessible walking/jogging path Community laundry room Barbecue grills and picnic tables Covered pavilion that includes barbecue grills and tables Swimming pool Furnished fitness center Equipped and functioning business center or equipped computer learning center Furnished community room Library Enclosed sun porch Service coordinator office Senior activity room Health screening room Secured entry Horseshoe pit, putting green or shuffleboard court Community dining room Children’s playscape(s) or Tot Lot(s) Sport court

Furnished and staffed children’s activity center Community theater room Green building amenities (indicate which below)

a. Evaporative coolers b. Passive solar heating/cooling c. Water conserving features d. Solar water heaters e. Irrigation and landscaping f. Sub-metered utility meters g. Energy Efficiency h. Thermally and draft efficient doors i. Photovoltaic panels for electricity j. Construction waste management k Recycling service provided throughout the compliance period l. Water permeable walkways m. Bamboo flooring, wool carpet, linoleum flooring; straw board, poplar OSB; or cotton batt insulation

form HUD-50070 (3/98)ref. Handbooks 7417.1, 7475.13, 7485.1 & .3

U.S. Department of Housingand Urban Development

Certification fora Drug-Free Workplace

Applicant Name

Program/Activity Receiving Federal Grant Funding

I certify that the above named Applicant will or will continueto provide a drug-free workplace by:

a. Publishing a statement notifying employees that the un-lawful manufacture, distribution, dispensing, possession, or useof a controlled substance is prohibited in the Applicant's work-place and specifying the actions that will be taken againstemployees for violation of such prohibition.

b. Establishing an on-going drug-free awareness program toinform employees ---

(1) The dangers of drug abuse in the workplace;

(2) The Applicant's policy of maintaining a drug-freeworkplace;

(3) Any available drug counseling, rehabilitation, andemployee assistance programs; and

(4) The penalties that may be imposed upon employeesfor drug abuse violations occurring in the workplace.

c. Making it a requirement that each employee to be engagedin the performance of the grant be given a copy of the statementrequired by paragraph a.;

d. Notifying the employee in the statement required by para-graph a. that, as a condition of employment under the grant, theemployee will ---

Acting on behalf of the above named Applicant as its Authorized Official, I make the following certifications and agreements tothe Department of Housing and Urban Development (HUD) regarding the sites listed below:

(1) Abide by the terms of the statement; and

(2) Notify the employer in writing of his or her convic-tion for a violation of a criminal drug statute occurring in theworkplace no later than five calendar days after such conviction;

e. Notifying the agency in writing, within ten calendar daysafter receiving notice under subparagraph d.(2) from an em-ployee or otherwise receiving actual notice of such conviction.Employers of convicted employees must provide notice, includ-ing position title, to every grant officer or other designee onwhose grant activity the convicted employee was working,unless the Federalagency has designated a central point for thereceipt of such notices. Notice shall include the identificationnumber(s) of each affected grant;

f. Taking one of the following actions, within 30 calendardays of receiving notice under subparagraph d.(2), with respectto any employee who is so convicted ---

(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or

(2) Requiring such employee to participate satisfacto-rily in a drug abuse assistance or rehabilitation program ap-proved for such purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;

g. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs a. thru f.

2. Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with theHUD funding of the program/activity shown above: Place of Performance shall include the street address, city, county, State, and zip code.Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.)

Check here if there are workplaces on file that are not identified on the attached sheets.

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.

(18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Name of Authorized Official Title

Signature Date

X

form HUD-92010 (3/2006) VA form 26-421

U.S. Department of Housingand Urban Development Office of Housing OMB Control No. 2502-0029Federal Housing Commissioner (exp. 9/30/2016)

Equal EmploymentOpportunity CertificationExcerpt From 41 CFR §60-1.4(b)

The applicant hereby agrees that it will incorporate or cause to beincorporated into any contract for construction work, or modifi-cation thereof, as defined in the regulations of the Secretary ofLabor at 41 CFR Chapter 60, which is paid for in whole or in partwith funds obtained from the Federal Government or borrowedon the credit of the Federal Government pursuant to a grant,contract, loan insurance, or guarantee, or undertaken pursuant toany Federal program involving such grant, contract, loan, insur-ance, or guarantee, the following equal opportunity clause:

During the performance of this contract, the contractor agrees asfollows:

(1) The contractor will not discriminate against any employee orapplicant for employment because of race, color, religion,sex, or national origin. The contractor will take affirmativeaction to ensure that applicants are employed, and that em-ployees are treated during employment without regard totheir race, color, religion, sex, or national origin, such actionshall include, but not be limited to the following: Employ-ment, upgrading, demotion, or transfer; recruitment or re-cruitment advertising; layoff or termination; rates of pay orother forms of compensation; and selection for training,including apprenticeship. The contractor agrees to post inconspicuous places, available to employees and applicantsfor employment, notices to be provided setting forth theprovisions of this nondiscrimination clause.

(2) The contractor will, in all solicitations or advertisements foremployees placed by or on behalf of the contractor, state thatall qualified applicants will receive considerations for em-ployment without regard to race, color, religion, sex, ornational origin.

(3) The contractor will send to each labor union or representativeof workers with which it has a collective bargaining agree-ment or other contract or understanding, a notice to beprovided advising the said labor union or workers' represen-tatives of the contractor's commitments under this section,and shall post copies of the notice in conspicuous placesavailable to employees and applicants for employment.

(4) The contractor will comply with all provisions of ExecutiveOrder 11246 of September 24, 1965, and of the rules, regu-lations and relevant orders of the Secretary of Labor.

(5) The contractor will furnish all information and reports re-quired by Executive Order 11246 of September 24, 1965, andby rules, regulations, and orders of the Secretary of Labor, orpursuant thereto, and will permit access to its books, records,and accounts by the administering agency and the Secretaryof Labor for purposes of investigation to ascertain compli-ance with such rules, regulations, and orders.

(6) In the event of the contractor's noncompliance with thenondiscrimination clauses of this contract or with any of thesaid rules, regulations, or orders, this contract may be can-celed, terminated, or suspended in whole or in part and thecontractor may be declared ineligible for further Govern-ment contracts or federally assisted construction contracts inaccordance with procedures authorized in Executive Order11246 of September 24, 1965, and such other sanctions maybe imposed and remedies invoked as provided in ExecutiveOrder 11246 of September 24, 1965, or by rule, regulation, ororder of the Secretary of Labor, or as otherwise provided by law.

(7) The contractor will include the portion of the sentence imme-diately preceding paragraph (1) and the provisions of para-graphs (1) through (7) in every subcontract or purchase orderunless exempted by rules, regulations, or orders of the Sec-retary of Labor issued pursuant to section 204 of ExecutiveOrder 11246 of September 24, 1965, so that such provisionswill be binding upon each subcontractor or vendor. Thecontractor will take such action with respect to any subcon-tract or purchase order as the administering agency maydirect as a means of enforcing such provisions, includingsanctions for noncompliance: Provided, however, That inthe event a contractor becomes involved in, or is threatenedwith, litigation with a subcontractor or vendor as a result ofsuch direction by the administering agency the contractormay request the United States to enter into such litigation toprotect the interests of the United States.

The applicant further agrees that it will be bound by the above equalopportunity clause with respect to its own employment practiceswhen it participates in federally assisted construction work:

Provided, That if the applicant so participating is a State or localgovernment, the above equal opportunity clause is not applicableto any agency, instrumentality or subdivision of such governmentwhich does not participate in work on or under the contract.

The applicant agrees that it will assist and cooperate actively withthe administering agency and the Secretary of Labor in obtainingthe compliance of contractors and subcontractors with the equalopportunity clause and the rules, regulations, and relevant ordersof the Secretary of Labor, that it will furnish the administeringagency and the Secretary of Labor such information as they mayrequire for the supervision of such compliance, and that it willotherwise assist the administering agency in the discharge of theagency's primary responsibility for securing compliance.

The applicant further agrees that it will refrain from entering intoany contract or contract modification subject to Executive Order11246 of September 24, 1965, with a contractor debarred from, orwho has not demonstrated eligibility for, Government contractsand Federally-assisted construction contracts pursuant to theExecutive order and will carry out such sanctions and penaltiesfor violation of the equal opportunity clause as may be imposed

Firm Name and Address By

Title

Department of Veterans Affairs

form HUD-92010 (3/06)VA form 26-421

upon contractors and subcontractors by the administering agencyor the Secretary of Labor pursuant to Part II, Subpart D of theExecutive order. In addition, the applicant agrees that if it fails orrefuses to comply with these undertakings, the administeringagency may take any or all of the following actions: Cancel,terminate, or suspend in whole or in part this grant (contract, loan,insurance, guarantee); refrain from extending any further assis-tance to the applicant under the program with respect to which thefailure or refund occurred until satisfactory assurance of futurecompliance has been received from such applicant; and refer the caseto the Department of Justice for appropriate legal proceedings.

Excerpt from HUD Regulations

200.410Definition of term “applicant”.

(a) In multifamily housing transactions where controls over themortgagor are exercised by the Commissioner either throughthe ownership of corporate stock or under the provisions ofa regulatory agreement, the term “applicant” as used in thissubpart shall mean the mortgagor.

(b) In transactions other than those specified in paragraph(a) ofthis section, the term “applicant” as used in this subpart shallmean the builder, dealer or contractor performing the con-struction, repair or rehabilitation work for the mortgagor orother borrower.

200.420Equal Opportunity Clause to be included in contracts andsubcontracts.

(a) The following equal opportunity clause shall be included ineach contract and subcontract which is not exempt:During the performance of this contract, the contractor agreesas follows:

(1) The contractor will not discriminate against any em-ployee or applicant for employment because of race, creed,color, or national origin. The contractor will take affirmativeaction to ensured that applicants are employed, and thatemployees are treated during employment without regard totheir race, creed, color, or national origin. Such action shallinclude, but not be limited to the following: employment,upgrading, demotion or transfer; recruitment or recruitmentadvertising; layoff or termination; rates of pay or other formsof compensation; and selection for training, including ap-prenticeship. The contractor agrees to post in conspicuousplaces, available to employees and applicants for employ-ment, notices to be provided setting forth the provisions ofthe nondiscrimination clause.

(2)The contractor will in all solicitations or advertisements foremployees placed by or on behalf of the contractor, state that allqualified applicants will receive consideration for employmentwithout regard race, creed, color, or national origin.

(3) The contractor will send to each labor union or repre-sentative of workers with which he has a collective bargain-ing agreement or other contract or understanding, a notice, tobe provided, advising the said labor union or workers’ repre-sentative of the contractor’s commitments under this section,and shall post copies of the notices in conspicuous placesavailable to employees and applicants for employment.(4) The contractor will comply with all provisions of Ex-ecutive Order 10925 of March 6 1961, as amended, and of theregulations, and relevant orders of the President’s Commit-tee on Equal Employment Opportunity created thereby.

(5) The contractor will furnish all information and reportsrequired by Executive Order 10925 of March 6, 1961, asamended, and by the regulations, and orders of the saidCommittee , or pursuant thereto, and will permit access to hisbooks, records, and accounts by HUD and the Committee forpurposes of investigation to ascertain compliance with suchregulations, and orders.

(6) In the event of the contractor’s non-compliance withthe nondiscrimination clause of this contract or with any ofthe said regulations, or orders, this contract may be can-celled, terminated or suspended in whole or in part and thecontractor may be declared ineligible for further Govern-ment contracts or Federally-assisted construction contractsin accordance with procedures authorized in Executive Order10925 of March 6, 1961, as amende, and such other sanctionsmay be imposed and remedies invoke s provided in the saidExecutive Order or by regulations, or order of the President’sCommittee on Equal Employment Opportunity, or as other-wise provided by law.

(7) The contractor will include the provisions of Para-graphs(1) through (7) in every subcontract or purchase orderunless exempted by regulations, or orders of the President’sCommittee on Equal Employment Opportunity issued pursu-ant to Section 303 of Executive Order 10925 of March 6,1961, as amended, so that such provisions will be bindingupon each subcontractor or vender. The contractor will takesuch action with respect to any subcontract or purchaseorders as HUD may direct as a means of enforcing suchprovisions, including sanctions for noncompliance: Provided,however, that in the event the contractor becomes involvedin, or is threatened with, litigation with a subcontractor orvender as a result of such direction by HUD, the contractormay request the United States to enter into such litigation toprotect the interests of the United States.

(b) Except in subcontracts for the performance of constructionwork at the site of construction, the clause is not required tobe inserted in subcontracts below the second tier. Subcontractsmay incorporate by referenced to the equal opportunity clause.

200.425Modification in and exemptions from the regulations inthis subpart.

(a) The following transactions and contracts are exempt from theregulations in this subpart:(1) Loans, mortgages, contracts and subcontracts not ex-ceeding $10,000.

(2) Contract and subcontracts not exceeding $100,000 forstandard commercial supplies or raw material;

(3)Contracts and subcontracts under which work is to be or hasbeen performed outside the United States and where no recruit-ment of workers within the United States in involved. To theextent that work pursuant to such contracts is done within theUntied States, the equal opportunity clause shall be applicable;(4) Contracts for the sale of Government property whereno appreciable amount of work is involved; and

(5) Contracts and subcontracts for an indefinite quantitywhich are not to extend for ore than one year if the purchaserdetermines that the amounts to be ordered under any suchcontract or subcontract are not reasonably expected to exceed$100,000 in the case of contracts or subcontracts for standardcommercial supplies and raw materials, or $10,000 in thecase of all other contracts and subcontracts.

OMB Number: 4040-0013 1 OMB Expiration Date: 01/31/2019

Federal Agency Form Instructions Form Identifiers Information

Agency Owner Grants.gov

Form Name Disclosure of Lobbying Activities (SF-LLL)

Form Version Number 1.2

OMB Number 4040-0013

OMB Expiration Date 01/31/2019

Form Field Instructions Field Number

Field Name Required or Optional

Information

1. *Type of Federal Action: Required Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

2. *Status of Federal Action Required Identify the status of the covered Federal action. This field is required.

2-a. a. Bid/Offer/Application Check if applicable

Click if the Status of Federal Action is a bid, an offer or an application.

2-b. b. Initial Award Check if applicable

Click if the Status of Federal Action is an initial award.

2-c. c. Post-Award Check if applicable

Click if the Status of Federal Action is a post-award.

3.0 *Report Type Required Identify the appropriate classification of this report.

3-a. a. Initial filing Check if applicable

Check if Initial filing.

3-b. b. Material change Check if applicable

If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.


Field Number


Information

Material Change Year Conditionally Required

If this is a follow up report caused by a material change to the information previously reported, enter the year in which the change occurred.

Material Change Quarter Conditionally Required

If this is a follow up report caused by a material change to the information previously reported, enter the quarter in which the change occurred.

Material Change Date of Last Report

Conditionally Required

Enter the date of the previously submitted report by this reporting entity for this covered Federal action.

4. Name and Address of Reporting Entity

Required Provide the information for Name and Address of Reporting Entity.

Prime Check if applicable

Click to designate the organization filing the report as the Prime Federal recipient.

Subawardee Check if applicable

Click to designate the organization filing the report as the SubAwardee Federal recipient. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

Tier if known: Optional Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier.

Name Required Enter the name of reporting entity. This field is required

Street 1 Required Enter Street 1 of the reporting entity. This field is required.

Street 2 Optional Enter Street 2 of the reporting entity.

City Required Enter City of the reporting entity This field is required.

State Required Enter the state of the reporting entity. This field is required

ZIP Required Enter the ZIP of the reporting entity. This field is required


Field Number


Information

Congressional District, if known Optional Enter the primary Congressional District of the reporting entity. Enter in the following format: 2 character state abbreviation – 3 characters district number, e.g., CA-005 for California 5th district, CA-012 for California 12th district, NC-103 for North Carolina’s 103rd district.

5. If Reporting Entity in No. 4 is Subaward, Enter Name and Address of Prime

Conditionally Required

If Reporting Entity in No. 4 is Subaward, provide the information for the Name and Address of Prime

Name Required If the organization filing the report in item 4, checks "Subawardee", enter the full name of the prime Federal recipient.

Street 1 Required If the organization filing the report in item 4, checks "Subawardee", enter the address of the prime Federal recipient.

Street 2 Optional If the organization filing the report in item 4, checks "Subawardee", enter the address of the prime Federal recipient.

City Required If the organization filing the report in item 4, checks "Subawardee", enter the city of the prime Federal recipient.

State Required If the organization filing the report in item 4, checks "Subawardee", select the appropriate state from this pull down menu.

ZIP Required Enter the ZIP of Prime. This field is required


Field Number


Information

Congressional District, if known Optional Enter the Congressional District of Prime. Enter in the following format: 2 character state abbreviation – 3 characters district number, e.g., CA-005 for California 5th district, CA-012 for California 12th district, NC-103 for North Carolina’s 103rd district.

6. Federal Department/Agency

Required Enter the name of the Federal Department or Agency making the award or loan commitment. This field is required.

7. CFDA Number: Required Enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. Pre-populated from SF-424 if using Grants.gov.

CFDA Title: Required Enter the Federal program name or description for the covered Federal action. Pre-populated from SF-424 if using Grants.gov.

8. Federal Action Number Optional Enter the most appropriate Federal identifying number available for the Federal action, identified in item 1 (e.g., Request for Proposal (RFP) number, invitation for Bid (IFB) number, grant announcement number, the contract, grant, or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001".

9. Award Amount Optional For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment of the prime entity identified in item 4 or 5.


Field Number


Information

10.a. Name And Address of Lobbying Registrant

Required Provide the information for the Name and Address of Lobbying Registrant.

Prefix Optional Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Lobbying Registrant.

First Name Required Enter the first name of Lobbying Registrant. This field is required.

Middle Name Optional Enter the middle name of Lobbying Registrant.

Last Name Required Enter the last name of Lobbying Registrant. This field is required.

Suffix Optional Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Lobbying Registrant.

Street 1 Required Enter the first line of street address for the Lobbying Registrant.

Street 2 Optional Enter the second line of street address for the Lobbying Registrant.

City Required Enter the city of the Lobbying Registrant.

State Required Select the appropriate state of the Lobbying Registrant.

ZIP Code Required Enter the Zip Code (or ZIP+4) of the Lobbying Registrant.

10.b. Individual Performing Services Required Provide the information for Individual Performing Services

Prefix Optional Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Individual Performing Services.

First Name Required Enter the first name of the Individual Performing Services. This field is required.

Middle Name Optional Enter the middle name of the Individual Performing Services.

Last Name Required Enter the last name of the Individual Performing Services. This field is required.


Field Number


Information

Suffix Optional Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Individual Performing Services.

Street 1 Required Enter the first line of street address for the Individual Performing Services.

Street 2 Optional Enter the second line of street address for the Individual Performing Services.

City Required Enter the city of the Individual Performing Services.

State Required Select the state for the address of the Individual Performing Services from this pull down menu.

ZIP Code Required Enter the Zip Code (or ZIP+4) of the Individual Performing Services.

11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

N/A N/A

Signature: Required Completed by Grants.gov upon submission.

Name: Required Provide the information for the Name of the Certifying Official.


Field Number


Information

Prefix Optional Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Certifying Official.

First Name Required Enter the first name of Certifying Official. This field is required.

Middle Name Optional Enter the middle name of the Certifying Official.

Last Name Required Enter the last name of the Certifying Official. This field is required.

Suffix Optional Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Certifying Official.

Title: Optional Enter the title of the Certifying Official.

Telephone No.: Optional Enter the telephone number of the certifying official.

Date: Required Completed by Grants.gov upon submission.

10. a. Name and Address of Lobbying Registrant:

9. Award Amount, if known:

$

* Street 1

* City State Zip

Street 2

* Last Name

Prefix * First Name Middle Name

Suffix

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352Approved by OMB

4040-0013

1. * Type of Federal Action:a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. * Status of Federal Action:a. bid/offer/application

b. initial award

c. post-award

3. * Report Type:a. initial filing

b. material change

4. Name and Address of Reporting Entity:

Prime SubAwardee

* Name

* Street 1 Street 2

* City State Zip

Congressional District, if known:

5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:

6. * Federal Department/Agency: 7. * Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

b. Individual Performing Services (including address if different from No. 10a)

Prefix * First Name Middle Name

* Street 1

* City State Zip

Street 2

11.

* Last Name Suffix

Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* Signature:

*Name: Prefix * First Name Middle Name

* Last Name Suffix

Title: Telephone No.: Date:

Federal Use Only: Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

Harris County Community Services Department

Section 3 Employment & Minority Business Plan

Page 1 of 7 Revised 5/18/18

As specified in Sections 4.2, 4.3 and 4.5 of the HUD bid specifications, all contractors and subcontractors

(whose contract amount exceeds a threshold of $100,000) are required to submit a complete Plan detailing

employment, as well as economic opportunities for small business enterprises, and to minority, women-

owned, Section 3 residents and business concerns (S/M/W/ Section 3 business enterprises). This Plan is due

within fifteen (15) working/business days after being notified as the apparent low bidder. Failure to

submit this Plan will render your bid as non-responsive.

Section 3 is a provision of the Housing and Urban Development (HUD) Act of 1968 that helps foster local

economic development, neighborhood economic improvement, and individual self-sufficiency. The Section

3 program requires that recipients of certain HUD financial assistance, to the greatest extent feasible, provide

job training, employment, and contracting opportunities for low or very low income residents in connection

with projects and activities in their neighborhoods.

I. Contract Information

Project Name:

Project Number:

Wage Decision Number:

Contract Amount: $

II. Contractor/Subcontractor Information

Name of Contractor/Subcontractor:

Address:

Contact Person/ Tel No.:

Contractor/Subcontractor’s

Federal Tax ID No.:

Contractor/Subcontractor’s

DUNS No.:

Names of three (3) Corporate Officers, if applicable:

1.

2.

3.

Total Number of Employees:

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

CSD Office Use Only

Date Monthly Report Received: _____________

of 7 Revised 5/18/18

III. Employment Projections

Table 1 below captures data on the contractors/subcontractor’s good faith effort (numeric goal) to employ

minorities, women, Section 3 and project area residents. Include additional rows and/or pages as needed.

Table 1. Employment Projections for Minorities, Women,

Section 3 Residents, and Project Area Residents

Project Numeric Goals

Job Category

Total

Needed to be

Hired

Minorities Women Section 3

Residents

Project Area

Residents

Para-professionals/

Technicians

Professionals

Office/Clerical

Construction by

Trade:

1. Laborers

2. Mechanics

(specify trade)

3.

Apprentices/

Trainees (specify

trade)

4. Add rows as

needed

NOTE: Section 3 Resident Certifications must be attached to this Plan, or forwarded to this office as soon as they become

available during the contract time for this project. All forms and certificates must be in their original form; copies will not be

accepted.

IV. Subcontracting Projections

Table 2 below captures data on the Contractors/Subcontractor’s good faith efforts (numeric goal) in

providing contracting opportunities to S/M/W/Section 3 businesses and project area firms.

Table 2. Subcontracting Projections for Minority, Women-Owned,

Section 3 Business and Project Area Businesses

Project Numeric Goals

Construction

By Trade

Category

Total

Subcontractors

Needed to be

Hired

Business Category (please check all that apply)

Small

Business

(SBE)

Minority-

owned

Business

(MBE)

Women-

owned

Business

(WBE)

Section 3

Business

(Section3

BE)

Project Area

Business

1. Electrical

2. Plumbing

3. Concrete

4. Carpentry

5. HVAC

6. Other

(Specify)

7. Add rows

and/or pages, if

needed NOTE: Section 3 Business Certifications must be attached to this Plan, or forwarded to this office as soon as they become

available during the contract time for this project. All certificate forms must be in their original form; copies will not be

accepted.


V. List of Subcontractors

List all proposed subcontractors in the format prescribed in Table 3 below. Add rows or pages as

needed.

Table 3. Subcontractor Information

Business Legal

Name

Trade

Category

Name of

Contact Address

Tel &

Fax

No.

FED

Tax ID

Business

Category1

Estimated

Contract

Amount

1. Electrical $

2. Plumbing $

3. Concrete $

4. Carpentry $

5. HVAC $

6. Other(specify) $

7. Add rows, if

needed

Other

(Specify) $

1 Indicate if subcontractor is a SBE, MBE, WBE, Section 3 BE, Project Area BE, or all or a combination.

NOTE: Section 3 Business Certifications must be attached to this Plan, or forwarded to this office as soon as they become

available during the contract time for this project. All forms and certificates must be in their original form; copies will not be

accepted.


VI. Outreach Efforts

Contractors/Subcontractors are required to conduct outreach to minority, women, Section 3

residents, Section 3 business concerns, and project area residents and businesses informing them

of employment and contracting opportunities for this contract. Evidence of good faith effort

solicitations includes a combination of the following outreach methods. Adequate back-up

documentation must be attached to this Plan for each method used.

Mark all that apply:

Newspaper Advertisements

Minority Media

Trade Association Publications

Postings of job openings at local community centers, public libraries, city hall.

Other Government Publications

Internet & Web Postings

Direct Contact by Phone, Fax, Mail outs

Meetings & Conferences

VII. Good Faith Effort Certification

I understand that it is my responsibility to comply with all federal, state and local regulations and

guidance in the identification, inclusion and utilization of S/M/W/Section 3 business enterprises

and M/W/Section 3 individuals in procurement efforts. I certify that I will make a good faith

effort to afford opportunities for S/M/W/Section 3 business enterprises and to M/W/ Section 3

individuals by:

1. Including qualified S/M/W/Section 3 business enterprises and qualified M/W/Section 3

individuals.

2. Soliciting potential S/M/W/Section 3 business enterprises and potential M/W/Section 3

individuals.

3. Reducing subcontract size/ quantities, when economically feasible, to permit maximum

participation by S/M/W/Section 3 business enterprises.

4. Establishing delivery schedules to encourage participation by S/M/W/Section 3 business

enterprises.

5. Using the services and assistance of the Small Business Administration, Minority Business

Development Agency, U.S. Department of Commerce, Texas Marketplace, and other

relevant entities.

I do declare and affirm that the contents of the foregoing are true and correct, and will

furnish subsequent documentation, which will attest to its accuracy.

President/Owner Name (Please Print)

Signature

Date:


Instructions to Complete the Employment and Minority Business Plan

Part I. Contract Information

Provide the Project Name, project Number and Contract Amount (this information will be

provided by CSD).

Part II. Contractor/Subcontractor Information

Provide Name of Contractor/Subcontractor, Address, Contract Person/Tel No.,

Contractor/Subcontractor’s Federal Tax ID No., and Contractor/Subcontractor’s DUNS No.

Total Number of Employees - include all number of company employees including office

personnel (do not include employees located in other cities or countries)

Part III. Employment Projections

Indicate the number of employees per job category, which will have to be hired for this contract,

including numeric goals for hiring within project area residents, minority, female employees, and

Section 3 residents. The minimum numerical goals are 30% of new full-time hires annually (i.e.

1 out of 3 new hires). Job categories are defined as follows:

Para-professional/ Professionals/ Managers/ Clerical – includes occupations requiring college

background knowledge, policy and decision-making skills, and clerical work, respectively;

examples include draftsman, architects, engineers, accountants, managers, administrative

assistants, clerical and office support.

Laborer – includes occupations (hourly workers) engaging in manual work requiring no special

training; examples include, but are not limited to gardeners, laborers, cleaners.

Mechanic – includes occupations requiring a high level skill, including occupations requiring

combination of basic scientific knowledge and manual skills; examples include, but are not

limited to carpenters, electricians, plumbers, cement masons, iron workers, etc.

Apprentice/Trainee – includes persons engaging in a training program to learn a trade or craft.

Part IV. Subcontracting Projections

Indicate the total number of subcontractors by work/ trade category (i.e., plumbing electrical,

concrete, etc.), which will be needed to complete this contract. The minimum numerical goals

are:

o 10% of total amount of all Section 3 covered contracts for building trades work and;

o 3% of the total dollar amount to all other contracts, such as professional service contracts.

See below for definitions of small, minority-owned, women-owned businesses, Section 3

business interest, and Section 3 resident.

o Small business: CSD uses the definition used by the Small Business Administration (SBA).

Therefore, the Small Business Act states that a small business concern is “one that is

independently owned and operated and which is not dominant in its field or operation.” The

law also states that in determining what constitutes a small business, the definition will vary

from industry to industry to reflect industry differences accurately. SBA’s Small Business

Size Regulations implement the Small Business Act’s mandate to SBA. SBA has also


established a table of size standards, matched to North American Industry Classification

System (NAICS) industries. For additional information please visit the http://www.sba.gov/.

o Minority or women owned business: For the purposes of these requirements, a minority

business enterprise represents a firm owned and controlled by one or more minorities or

women (51% or more), and meet the following criteria:

1. Minority groups members who are Black Americans, Hispanic Americans, Native

Americans, Asian-Pacific Americans, Asian-Indian Americans and any other minorities

or individuals found to be disadvantaged by the Small Business Administration (SBA);

2. Must be an independent business;

3. Ownership and control by minorities or women shall be real, substantial, and continuing

and shall go beyond proforma ownership of the term as reflected in its ownership

documents; and

4. Must be a small business as defined by SBA.

o Section 3 business interests: A Section 3 business interest is a business that meets the

following criteria:

· The business is 51% or more owned by Section 3 residents; or

· Whose permanent, full-time workforce includes persons, at least 30% of whom are

currently qualified Section 3 residents, or within three (3) years of the date of first

employment with the business were Section 3 residents; or

· Commits to subcontractor in excess of 25% of its total subcontracting to Section 3

companies.

o Section 3 resident: A Section 3 resident is a person that meets the income eligibility

guidelines for low and very low income as published by the U.S Government. See Table 4

below for the Median Family Income Limits.

Part V. List of Subcontractors

List the business legal name, trade category, name of contact, address, telephone & fax number,

Federal Tax ID, business category (if applicable) and estimated contract amount for the

subcontractor hired for this project.

Part VI. Outreach Efforts

Appropriate back up documentation, including but not limited to copies of printed

advertisements (newspapers, trade publications, and etc.), copies of job postings, copies of faxes

and mail outs, and copies of internet postings must be attached to this Plan. Any subsequent

documentation must be forwarded to this office as soon as they become available during the

course of this project.

Part VII. Good Faith Effort Certification

Print name, sign and date certifying compliance with all program requirements.

http://www.sba.gov/


Additional Resources

The following list, which may not be all inclusive, is intended to assist contractor/subcontractor’s

to identify, include, and utilize minority, women-owned and Section 3 business enterprises in

implementing the subject contract.

The City of Houston – Minority, Women-owned, and Disadvantage Business Enterprise

Directory –

http://houston.mwdbe.com/FrontEnd/VendorSearchPublic.asp?TN=Houston_Diversity

Small Business Administration’s Dynamic Small Business Search – http://dsbs.sba.gov/

SBA-DSBA is an Internet-based system that allows contractors/subcontractors to search for

small, minority and women-owned businesses in their area.

Small Business Administration’s (SBA) Sub-Net – http://web.sba.gov/subnet

Sub-Net is an Internet-based system that allows contractors/subcontractors to post their

procurement opportunities online, Access to the database is free to government agencies and

Contractors/Subcontractors, and is an excellent source for soliciting, small, minority, women

business enterprises.

Women Contractor Association – http://www.womencontractors.org/

Located in Houston, this organization provides contractors/subcontractors with resources to

identify, include and utilize women-owned businesses.

Minority Business Development Agency (MBDA) of the U.S. Department of Commerce –

http://www.mbda.gov/?section_id=2

National Association of Minority Contractor’s (NAMC) - Houston Chapter –

http://www.namc-houston.org/

Houston Minority Business Council – http://www.hmbc.org/

Houston Hispanic Chamber of Commerce –

http://www.houstonhispanicchamber.com/hhcc/Default_EN.asp

Houston Citizen’s Chamber of Commerce – http://www.hccoc.org/

http://houston.mwdbe.com/FrontEnd/VendorSearchPublic.asp?TN=Houston_Diversity

http://dsbs.sba.gov/

http://web.sba.gov/subnet

http://www.womencontractors.org/

http://www.mbda.gov/?section_id=2

http://www.namc-houston.org/

http://www.hmbc.org/

http://www.houstonhispanicchamber.com/hhcc/Default_EN.asp

http://www.hccoc.org/

OMB Number: 4040-0009 Expiration Date: 01/31/2019

ASSURANCES - CONSTRUCTION PROGRAMS

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503.

Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.

As the duly authorized representative of the applicant:, I certify that the applicant:

NOTE:

1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project costs) to ensure proper planning, management and completion of project described in this application.

2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, the right to examine all records, books, papers, or documents related to the assistance; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

3. Will not dispose of, modify the use of, or change the terms of the real property title or other interest in the site and facilities without permission and instructions from the awarding agency. Will record the Federal awarding agency directives and will include a covenant in the title of real property acquired in whole or in part with Federal assistance funds to assure non-discrimination during the useful life of the project.

4. Will comply with the requirements of the assistance awarding agency with regard to the drafting, review and approval of construction plans and specifications.

5. Will provide and maintain competent and adequate engineering supervision at the construction site to ensure that the complete work conforms with the approved plans and specifications and will furnish progressive reports and such other information as may be required by the assistance awarding agency or State.

6. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.

7. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.

8. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards of merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

9. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of lead-based paint in construction or rehabilitation of residence structures.

10. Will comply with all Federal statutes relating to non-discrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681 1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29) U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statue(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statue(s) which may apply to the application.

Previous Edition Usable Authorized for Local Reproduction Standard Form 424D (Rev. 7-97) Prescribed by OMB Circular A-102

11. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal and federally-assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.

12. Will comply with the provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

13. Will comply, as applicable, with the provisions of the Davis- Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327- 333) regarding labor standards for federally-assisted construction subagreements.

14. Will comply with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

15. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91- 190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of

Federal actions to State (Clean Air) implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205).

16. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.

17. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§469a-1 et seq).

18. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations."

19. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE

SF-424D (Rev. 7-97) Back

APPLICANT ORGANIZATION DATE SUBMITTED

20. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohibits grant award recipients or a sub-recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award.