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HomeMy WebLinkAboutSeminole County Interlocal CDBG 1999-2000 , , RECEIVED APR 1, 7 2000 SEMINOLE COUNTY/CITY OF WINTER SPRINGS INTERLOCAL AGREEMENT COMMUNITY DEVELOPMENT BLOCK GRANT PROG PROGRAM YEAR 1999-2000 roJr & ~ U ~ fii1 WI Am -um Il~ J COMMUNITY ~EVELOPMENT OFFiCE CITY OF WINTER SPRINGS Community Developme'nt THIS AGREEMENT, entered into this 30 day of /?JA/C-c~ ~ by and between SEMINOLE COUNTY, a political subdivision of the State of Florida, whose address 1S 1101 East First Street, Winter Springs, Florida 32771, hereinafter referred to as "COUNTY," for the use and benefit of its Community Development Block Grant (CDBG) Program and the CITY OF WINTER SPRINGS, a municipality incorporated under the laws of the State of Florida, whose mailing address is 1126 East State Road 434, Winter Springs, Florida 32708, hereinafter referred to as "WINTER SPRINGS" . WHEREAS, COUNTY has made application effective October 1, 1999, and. entered into a contract with the United State~ Department of Housing and Urban Development, hereinafter referred to as "HUD," pursuant to Title I, Housing and Community Development Act of 1974, as amended, and implementing regulations set forth in 24 Code of Federal Regula tions (CFR) Part 570; and WHEREAS, pursuant. to the HUD application, the COUNTY shall undertake certain acti vi ties to develop a viable community, including, but not limited to, a suitable living environment and improved quality of life, principally for persons of low and moderate lncome, as described in the CDBG Program application; and WHEREAS, WINTER SPRINGS shall provide for professional construction administration services for infrastructure improvements within WINTER SPRINGS to benefit low and moderate income residents of Seminole County, Florida; and 1 CERTIFIED COpy M r...RY !\NNE MO~SE Cl.r;::,\ OF C!t:C!J1T COURT S~!'.~~:~GLE COU~n'(, FLORID" ,,&~ /fi~--/~_, B. DfJ>\JTY C~~ ,". . ~ ) ; WHEREAS, the COUNTY has deemed that these serVlces serve a COUNTY purpose and desires to engage WINTER SPRINGS to render services necessary to achieve the aforesaid objectives; and WHEREAS, the COUNTY has allocated CDSG funds for community development activities provided by WINTER SPRINGS, NOW, THEREFORE, in consideration of the mutual covenants, promises and representations contained herein and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: Section 1. Reci ta1s. The above recitals are true and form a material part of the Agreement upon which the parties have relied. Section 2. Definitions. (a) "CDBG Administrator" means the Seminole County Community Development Principal Planner. (b) "CDBG Program" means the Seminole County CDSG Program. (c) "CDBG Regulations" means 24 CFR Part 570 and supplemental, additional or successor provisions. (d) "County Approval" means written approval by the Planning Director, Community Development Principal Planner, or their designee. (e) "Low and Moderate Income" means gross household income not to exceed eighty percent (80%) of the median family income within the Orlando Metropolitan Statistical Area during the Agreement. (f) "Planning Department" means the COUNTY I s Planning and Development Department Director or his designee for the Community Development Office. Section 3. Statement of Work. (a) WINTER SPRINGS, ina manner satisfactory to the COUNTY, shall perform or cause to be performed all services described or referred to 2 in Exhibit "A," General Scope of incorpora ted herein by re ference. except as otherwise speci fically instrumentalities solely under the Such Services, services attached hereto and shall be performed, stated. herein, by persons or dominion and control of WINTER SPRINGS. (b) The parties recognize and agree that the purpose of this Agreement is to reimburse the cost of providing professional construction administration services for engineering and design of street lights, repaving and sidewalks and associated infrastructure improvements to benefit low and moderate income residents of WINTER SPRINGS and the Agreement is directly related to the implementation of the CDBG program. Where service expenses are authorized by the COUNTY as set forth in Exhibit "B," those expenses shall be specifically itemized by the hours or dollars expended or as otherwise required by applicable laws, rules and regulations. All hours charged by staff and direct expenses shall be specifically and directly related to WINTER SPRINGS' implementation of the CDBG activity funded under this Agreement. Section 4. Term. The COUNTY shall reirrlburse WINTER SPRINGS for the services described in Exhibit "A," performed by WINTER SPRINGS up to the limits set forth in Section 5. All such services shall be performed by WINTER SPRINGS in accordance with applicable requirements of HUD with reimbursement contingent thereupon. WINTER SPRINGS shall perform all services described in Exhibit "A," on or before June 30, 2001, unless the Agreement is otherwise amended or extended by written agreement of the parties as provided hereunder. The Agreement shall be effective upon execution by both parties. 3 Section 5. Consideration and Limitation of Costs. The COUNTY shall reimburse WINTER SPRINGS for costs, In accordance with the Agreement and 24 CFR Part 570, in an amount not to exceed EIGHTY THREE THOUSAND TWO HUNDRED AND NO/lOO DOLLARS ($83,200.00) for the services described in Exhibit "A". Section 6. Payments. (a) Payment to WINTER SPRINGS shall be on a reimbursement basis limited to the items budgeted in the Project Budget, attached hereto and incorporated herein by reference as Exhibit "B". Payment may also be made directly to the vendor, pursuant to the conditions set forth in subsection (b) below. (b) WINTER SPRINGS shall submit to the COUNTY by the fifteenth (15th) day of each month during the term hereof, the following: - 1. A st'atement' of all costs of services for the period from commencement through the end of the report period for which the statement is submitted; 2. A statement of all costs of services for the current report period, categorized by budget line item and consistent with Exhibit "B"; 3. An invoice and copies of receipts or other acceptable documentation issued for payment of any expense. (c) Upon receipt of the documentation listed above, the COUNTY shall initiate the payment .process. Reimbursement to WINTER SPRINGS shall be made as soon as practicable; provided, however, that if WINTER SPRINGS has performed services in full compliance 'with all HUD requirements, payment shall be made by the COUNTY to WINTER SPRINGS within forty-five (45) days of receipt of documentation by the COUNTY. 4 (d) All disbursements by WINTER SPRINGS must be fully documented to the COUNTY and available, upon request, for all inspection or audit in ,accordance with the provisions of Section 13 below. (e) Within forty-five (45) days after completion of all services to be performed, WINTER SPRINGS shall render a final and complete statement to the COUNTY of' all costs and charges to services not previously invoiced. The COUNTY shall not be responsible for payment of any charges, claims or demands of WINTER SPRINGS not received within said forty-five (45) day period. However, such time m~y be extended in writing, at COUNTY's discretion, not to exceed a period of ninety (90) days, provided the delay in submission is not occasioned by any fault or negligence of WINTER SPRINGS, as determined by the COUNTY. Section 7. Uniform Administrative Requirements. In addition to all other Federal, State and local requirements for the performance of the Agreement, WINTER SPRINGS shall comply with the requirements set forth in 24 CFR Part 85 "Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments," OMB Circular No. A-1 02, "Grants and Coopera ti ve Agreements wi th Sta te and Local Governments," and OMB Circular No. A-8?, "Cost Principles for State and Local Governments". Section 8. Compliance with other Program Requirements. (a) During the Agreement, WINTER SPRINGS shall comply with all Federal laws, rules, regulations, directives and orders described in 24 CFR 570 Subpart K and the regulations listed below which by reference are incorporated herein and made a part hereof. 1. 24 CFR Part 1 ~. The regulations promulgated pursuant to Title VI, 1964 Civil Rights Act', Public Law 88-352. 5 2. Title VII, 1968 Equal Employmen t Opportuni ty discrimination in employment. 3. Ti tie VI I I, 1968 Civil Righ ts Act, Public Law 90-284 _ The Fair Housing Act requires HUD to administer the activities and programs relating to housing and urban development in a manner that affirmatively furthers fair housing. 4. 24 CFR Part 107 - Implementing Executive Order 11063, as amended by Executive Order 12259, which directs HUD to take all action necessary to prevent discrimination because of race, color, religion Ci vii Righ ts Act of 1972 Act as amended by the ("Act")' Prohibits (creed), sex, or national origin in the sale, lease, rental, or other disposition of residential property and related facilities when provided in whole, or in part, with Federal assistance. 5. Section 109 of the Act - Requires that no person shall, on the ground of race, color, national origin or sex be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with community development funds. Section 109 of. the Act further prohibits against discrimination on the basis of age under the Age Discrimina tiOD Act of 1973, or with respect to an otherwise qualified handicapped person as provi<;ied in Section 504, Rehabili ta tion Act of 1973. 6. Section 110, Labor Standards - Required compliance with the Davis-Bacon Act, as amended, pursuant to 29 CFR parts 3.5 and 5a; and the Contract Work Hours and Safety Standards Act, where applicable. 7. National Flood Disaster Act - Governs participation in the National Flood Insurance Program, pursuant to Section 202(a) of said Act. 6 8. Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, HUD implementing regulations at 24 CFR Part 43 and Section 104 of the Act, - Provides for the protection of individual rights when affected, by relocation acquisition and displacement activities. 9. Executi ve Order 11246, as amended by Executive Order 12086, - Provides that no person should be discriminated against on the basis of race, color, religion, sex or national origin in al phases of employment during the performance of Federally assisted construction contracts. 10. Section 3, Housing and Urban Development Act of 1968 - Requires HUD recipients to provide, to the greatest extent feasible, opportunities for training and employment to very low income persons. 11. Lead-Based Paint Poisoning Prevention Act - Prohibits the use of lead-based paint and provides for the elimination of lead- based paint in all residential structures constructed or rehabilitated with Federal Assistance. 12. 24 CFR part 24 - Provides that assistance shall not be used directly or indirectly to employ, award contracts to, or otherwise engage the services of, or fund any contractor or WINTER SPRINGS during any period of debarment, suspension, placement in ineligibility status under the provisions of 24 CFR part 24. 13. Conflict of Interest the provisions of 24 CFR Part 84.42, Provides that compliance with 24 CFR Part 570.611 and OMB Circular A-IIO is mandatory, 14. 24 CFR. Part 570 Provides for compliance with regulations regarding the CDSG Program. 7 " . b. WINTER SPRINGS shall neither 8 assume the COUNTY's shall recognize the Seminole County Board of County Commissioners as the recipient funded by HUD and providing funds to WINTER SPRINGS. Section 12. Management Assistance. The CDBG Administrator or his designee shall be available to WINTER SPRINGS to provide guidance on CDBG requirements. Section 13. Maintenance of Records. a. WINTER SPRINGS shall, at a minimum, maintain all records required by Federal, State and local laws, rules and regulations. b. WINTER SPRINGS shall maintain all records, including accounts and property and personnel records, as deemed necessary by the COUNTY or considered a sound business practice to ensure proper accounting of all project funds and compliance with the Agreement. c. WINTER SPRINGS shall maintain financial records required by Federal regulations in addition to financial records relative. to the. following matters: 1. Items purchased and paid for through standard WINTER SPRINGS procedures: invoices and copies of canceled checks. 2. Agreements: the contract, billings and copies of canceled checks. 3. Force account construction: records indicating name, position, "number of hours arid total labor costs. 4. Capi tal expenditures in excess of THREE HUNDRED AND NO/lOO DOLLARS ($300.00) : description, model, serial number and date and cost of acquisition. d. WINTER SPRINGS s.hall perform or cause to be performed an annual audit of its activities and funds in accordance with each regular WINTER SPRINGS audit. Copies oE all audits relating to the use of COBG 9 funds shall be provided to COUNTY and the CDBG Administrator In a timely manner. e. All records and contracts, of wha tsoever type or nature, required by the Agreement shall be available for audit, inspection and copying in accordance with Chapter 119, Florida Statutes. The COUNTY shall have the right to obtain and inspect any audit pertaining to the performance of the Agreement made by any Federal, State or local agency. WINTER SPRINGS shall retain all records and supporting documentation applicable to the Agreement for a minimum of five (5) years after resolution of the final audit and in accordance with Florida law. Section 14. Reporting Requirements. WINT.ER SPRINGS shall fully complete and provide to the COUNTY and CDBG Administrator monthly reports utilizing the "Request for Funds Reimbursement Report," attached hereto and incorporated herein as Exhibit "C". WINTER SPRINGS shall provide the reports as part of the financial reimbursement process no later than the fifteenth (15th) day of each month. WINTER SPRINGS shall fully complete and provide to the CDBG Administrator by the fifteenth (15th) day of each month a "Monthly Status Report," attached hereto and incorporated herein as Exhibit "~'. WINTER SPRINGS shall fully complete and provide to the CDBG Administrator, in a timely manner, an "End of Year Report," attached hereto and incorporated herein as Exhibit "E". The COUNTY shall have access to and be provided copies and transcripts of any records necessary in the sole determination of the COUNTY or HUD to accomplish this obligation. Section 15. Non-Expendable Property. Any non-expendable personal property acquired by WINTER SPRINGS to perform the projects herein and approved by the COUNTY as set forth in Section 10 herein, shall be subject to all Federal, State' and local regulations, including, but not 10 1 imi ted to, the provisions on use and disposition of property. At the termination of this Agreement, any grant-funded non-expendable personal property shall be made available to the COUNTY and HUD in accordance with the aforesaid provisions. Section 16. Liability. Except for reimbursement as specifically set forth herein, the COUNTY shall not be liable to any person, firm, entity or corporation in connection with the services WINTER SPRINGS has agreed to perform hereunder, or for debts or claims accruing to such parties against WINTER SPRINGS. The Agreement shall not create a contractual relationship, either express or implied, between COUNTY and any other person, firm, or corporation supplying any work, labor, services, goods or materials to WINTER SPRINGS as a result of services to COUNTY hereunder. Section 17. Subcontracts. All contracts made by WINTER SPRINGS to perform the activities described in Exhibit "A" shall comply with all applicable laws, rules and regulations set forth in the Agreement. Any addi tional work or services subcontracted hereunder by WINTER SPRINGS shall be specified in writing and subject to the Agreement. Section 18. Indemnification. (a) To the extent permitted by law, WINTER SPRINGS shall defend, hold harmless and indemnify the COUNTY from and against any and all liability, loss, claims, damages, costs, attorney's fees and expenses of whatsoever kind, type~ or nature which the COUNTY may sustain, suffer or incur or be required to pay by reason of the loss of any monies paid to WINTER SPRINGS or whomsoever, resulting out of WINTER SPRINGS's fraud, defalcation, dishonesty, or failure of WINTER SPRINGS to comply with applicable laws or regulations; or by reason or as a result of any act or omission of WINTER SPRINGS in the performance of the Agreement or any 11 part thereof; or by reason of a judgment over and above the limits provided by the insurance required hereunder or by any defect in the construction of the project;', or as may otherwise result In any way or instance whatsoever arising from this Agreement. (b) In the event that any action, suit or proceeding is brought against the COUNTY upon any alleged liability arising out of the Agreement, or any other matter relating to this Agreement, the COUNTY shall promptly provide notice in writing thereof to WINTER SPRINGS by registered or certified mail addressed to WINTER SPRINGS at the address provided hereinafter. Upon receiving such notice, WINTER SPRINGS, at its own expense and to the extent permitted by law, shall diligently defend against such action, suit or proceeding and take all action necessary or proper to prevent, to the extent practicable, the obtaining of a judgment against the COUNTY. The COUNTY shall cooperate to a reasonable extent in WINTER SPRINGS's defense of any such action, suit or proceeding. Section 19. Insurance. WINTER SPRINGS shall ensure that its insurance coverage or self-insurance program, or the lnsurance coverage of its contracted agents is adequate and sufficient for the activities performed pursuant to the Agreement. WINTER SPRINGS shall ensure that the insurance requirements imposed on all contractors conform to and comply with all applicable Federal, State and local regulations. Section 20. Non-Assignability. Neither party.. shall assign the Agreement without the prior written consent of the other. Section 21. Headings., All articles and descriptive headings of paragraphs In this Agreement are inserted for convenience only and shall not affect the construction or interpretation hereof. 12 Section 22. Program Income. (a) In the event that any program income received by WINTER SPRINGS during the Agreement, return such income to the COUNTY. (b) If any program income (returned funds) is received by WINTER SPRINGS after expiration of the Agreement or at the end of the year when all remaining items have been budgeted, the program income shall be returned to the COUNTY for proper accounting in the CDBG fund. Section 23. Suspension and Termination. In accordance with 24 CFR Parts 84.60 -.62, the COUNTY may immediately suspend or terminate any term or condition hereunder. Notice thereof shall be provided pursuant to the Agreement. The Agreement may also be terminated for convenience in accordance with 24 CFR part 85.44, providing for (returned funds) is WINTER SPRINGS shall termination for mutual convenience, or partial termination for specified reasons. The Agreement may also be terminated immediately by the COUNTY for cause. Section 24. Reversion of Assets. Upon expiration of the Agreement, WINTER SPRINGS shall transfer to the COUNTY any remaining COBG funds and any accounts receivable attributable to the use of CDBG funds. Any real property controlled by WINTER SPRINGS and acquired or improved in whole, or in part, with CDBG funds in excess of TWENTY-FIVE THOUSAND AND NO/lOO DOLLARS ($25,000.00) shall be governed by 24 CFR 84.34(g) . Section 25. Certification Regarding Lobbying. WINTER SPRINGS hereby certifies, by examination of the Agreement, that, to the best of its knowledge and belief: (a) No Federally appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing 13 or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan or cooperative agreement. (b) If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or any employee of a member of Congress in connection with this Agreement, WINTER SPRINGS shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," In accordance with its instructions. Section 26. Notice. Whenever either party desires to give notice unto the other, notice may be sent to: For COUNTY: COBG Administrator Community Development Office Seminole County Services Building 1101 East First Street WINTER SPRINGS, Florida 32771 For WINTER SPRINGS: City Manager City of Winter Springs 1126 East State Road 434 Winter Springs, Florida 32708 Either of the parties may change, by written notice as provided herein, the address or person for receipt of notice. 14 Section 27. Conflict of Interest. (a) WINTER SPRINGS agrees that it will not engage In any action that would create a conflict of interest in the performance of its obligations pursuant to the Agreement with the COUNTY or which would violate or cause others to violate the provisions of Part III, Chapter 112, Florida Statutes, relating to ethics in government. (b) WINTER SPRINGS hereby certifies that no officer, agent or employee of the COUNTY has any material interest (as defined in Section 112.312(15), Florida Statutes, as over 5%) either directly or indirectly, in the business of WINTER SPRINGS to be conducted here, and that no such person shall have any such interest at any time during the term of the Agreement. (c) Pursuant to Section 216.347, Florida Statutes, WINTER SPRINGS hereby agrees that monies received from the COUNTY pursuant to the Agreement will not be used for the purpose of lobbying the Legislature or any other State or Federal Agency. Section 28. Entire Agreement, Effect on Prior Agreement. This instrument constitutes the entire agreement between the parties and supersedes all previous discussions, understandings and agreements, if any, between the parties relating to the subj ect matter of the Agree- ment. Section 29. Modification. This Agreement may not be modified, amended or extended orally. This Agreement may be amended by written agreement duly executed by the governing bodies of both parties. Section 30. Remedies. Upon determination that a breach has occurred and in addition to ,the remedies provided by law, the COUNTY may elect any of the following remedies, as applicable and appropriate: 15 (a) Terminate the Agreement and designate the remaining uncommit- ted funds for any other eligible program or activity or to the COUNTY's trust fund without further obligation to WINTER SPRINGS, and require WINTER SPRINGS to repay any monies expended In violation of the Agreement. (b) Require specific performance of the Agreement. (c) Demand payment and/or performance from the surety, if applicable. Section 31. Severability. ( If anyone or more of the covenants or provisions of the Agreement shall be held to be contrary to any express provision of law or contrary to the policy of express law, though not expressly prohibited, or against public policy, or shall, for any reason whatsoever, be held invalid, then such covenants or provisions shall be null and void, shall be deemed separable from the remaining covenants or provisions of the Agreement, and shall, in no way, affect the validity of the remaining covenants or provisions of the Agreement. IN WITNESS WHEREOF, the parties hereto have caused the Agreement to be executed on the date hereinabove first written. CI By: Date: ~~Y "q ~ [ 16 \ ATTEST: ~ Clo k to the B~ard- O-f County Commissioners of Seminole County, Florida. By: For the use and reliance of Seminole County only. Approved as to form and legal sufficiency. Date, -rCYCJ3 As authorized for execution by the Board of County Commi)sion ~7 at their /J/4A::...d.. 1. h' , ~.lOOD, regular meeting. . 40dAJ t} ~ 3.1~i)t) County Attorney 5 Attachments: 1. Exhibit "K' - General Scope of Services 2. Exhibi t "B" - proj ect Budget 3. Exhibit "c" - Request tor Funds Reimbursement Report 4. Exhibit \\ D" - Subrecipient Report (Monthly Status Report) 5. Exhibit "E" - Ertd of Year Report SED/lpk 11/4/99 \\CA_CSB\SYS\CA\Users\CALK01\MYDOCS\AGT\wintersprings-cdbg.doc 17 EXHIBIT "A" GENERAL SCOPE OF SERVICES CITY shall provide for professional construction administration services to ensure the proper installation of streetlights, re-paving and sidewalks on Rhoden Lane in Winter Springs, Florida. TASK ONE: DOCUMENTS CITY shall prepare all documents required for bidding. The document shall be submitted to the COUNTY for review and approval prior to bidding. The COUNTY shall review the documents and incorporate terms and conditions as required by the COUNTY or by Federal requirements. TASK TWO: BID ADVERTISEMENT CITY shall properly advertise bids and provide contractors a specific response period. All procurement of labor, materials and services shall comply, at a minimum, with Federal Office of Management and Budget (OMB) Circular A-110, as revised and amended. TASK THREE: BID RESPONSE REVIEW Following-the close of the bidding period, the COUNTY and CITY shall jointly review the bids and contractor qualifications and the CITY shall make the appropriate bid and contract award. TASK FOUR: CONTRACTOR SELECTION CITY shall select the contractor to be awarded the construction work. CITY shall prepare and negotiate the' contract with the contractor and monitor the performance to meet certain requirements, such as, but not limited to, certificates and permits. CITY shall facilitate, in cooperation with the COUNTY, any requirements necessary for the COUNTY to comply with Federal guidelines. TASK FIVE: PRE-CONSTRUCTION CONFERENCE CITY and COUNTY shall hold a joint pre-construction conference with the contractor for the purpose of: 1. Identifying the project manager; 2. Identifying the field monitors; 3. Discussing the plans and specifications; 4. Discussing construction procedures and scheduling; 5. Answering any questions prior to construction; and 6. Discussing Federal requirements and regulations (COUNTY staff shall present this information.) \lDP\ VOL2\CP\CD\N Ew\PROJ ECTS\WSPRI NGS\EXHBT A, DOC EXHIBIT "A" (Continued) GENERAL SCOPE OF SERVICES TASK SIX: CONSTRUCTION MONITORING CITY shall provide a project manager to monitor and inspect the construction activities. The project manager shall be responsible for responding to all reasonable requests by the COUNTY or contractor. The project manager or his/her designee shall provide liaison and progress reports to the COUNTY. TASK SEVEN: , PROGRESS REPORTS CITY'S project manager or designee shall provide monthly written progress reports to the COUNTY by the fifteenth (15th) day of every month. TASK EIGHT: PROJECT SUMMARY CITY shall prepare a written summary for the COUNTY, to complete documentation of the project. \\OP\ VOL2\CP\CD\NEw\PROJ ECTS\WSPRI NGS\EXHBT A. DOC EXHIBIT B Project Budget City of Winter Springs Activity Bud~et Engineering & Design and Construction Services for the Installation of Street lights, Road Re-paving and Installation of Sidewalks on Rhoden Lane in Winter Springs, Florida CDBG 1999-2000 $83,200 s :\cp\cd\new\proj ec Is\wH\exhbls, doc EXHIBIT C SEMINOLE COUNTY COMMUNITY DEVELOPMENT BLOCK GRANT REQUEST FOR FUNDS REIMBURSEMENT REPORT (FISCAL YEAR 1999-2000) COMMUNITY DEVELOPMENT STAFF USE ONLY ACCOUNT NO. FINANCE DIRECTOR SECTION I - REQUEST FOR FUNDS 1. SUBRECIPIENT NAME: 2. ADDRESS: 3. REQUEST DATE: 4. REQUEST NO.: FINAL REQUEST: YES NO 5. CONT ACT PERSON: 6. TELEPHONE NUMBER: -( COMPLETE SECTION II EXPENSE SUMMARY BEFORE GOING TO ITEMS 7-12. 7. FUNDS ARE HEREBY REQUESTED FOR EXPENDITURTES INCURRED IN THE MONTH(s) OF: 8. TOTAL CASH EXPENDITURES FROM START OF SUBGRANT TO DATE (FROM SECTION II, LINE 4): $ 9. CASH RECEIPTS FROM START OF SUBGRANT TO DATE: $ 10. REIMBURSEMENT FUNDS REQUESTED FOR THIS PERIOD (LINE 8 MINUS LINE 9) $ 11. SUBMITTED BY: 13. TITLE: 12, AUTHORIZED SIGNATURE: (This form Is for reproduction or copying by Recipient) s :\cp\cd\new\projects\wff\exhbts, doc SECTION II - EXPENSE SUMMARY FISCAL YEAR 1999 - 2000 SUBRECIPIENT NAME: EXPENSE SUMMARY FOR: (Month & Year) DISCRIPTION BUDGET CURRENT EXPENSES EXPENSES , AVAILABLE OF REVISED THIS Y-T-D BALANCE ACTIVITY BUDGET MONTH 1. 2. TOTAL A. B. C. D. E. $ $ $ $ S $ 3. ENTER TOTAL CASH EXPENDITURES ADMENDMENTJOURNAL REPORTED ON THE PREVIOUS "EXPENSE $ REPORT AND REQUEST FOR FUNDS' (SECTION I, LINE 8) 4. COMPUTE "TOTAL CASH EXPENDITURES FROM START OF SUBGRANTTO DATE" BY $ ADDING 2C AND 3. (ENTER RESULT ON LINE 8 SECTION I) ATTACH A COPY OF ALL SUPPORTING DATA FOR THE PERIOD THIS EXPENSE SUMMARY ADDRESSES I.e., LABOR VOUCHERS, RECEIPTS, INVOICES, DAILY ACTIVITY LOGS, ETC.. (This form Is for reproduction or copying by Recipient.) s :\cp\cd\new\proj ects\wff\exhbts ,doc SECTION 11I- STATUS REPORT FY 1999-2000 1. SUBRECIPIENT NAME: 2. STATUS REPORT FOR THE MONTH OF: 3. ACTIVITY NAME: 4. ESTIMATED PROJECT/ACTIVITY COMPLETION DATE: 5. PERCENT OF PROJECT/ACTIVITY COMPLETED TO DATE: 6. DESCRIBE SPECIFIC WORK TASKS AND QUANTIFIED ACCOMPLISHMENTS COMPLETED THIS MONTH. 7. DESCRIBE PROJECT/ACTIVITY SUCCESSES, OR PROBLEMS ENCOUNTERED AND THEIR SOLUTIONS. 8. DISCUSS ANY ANTICIPATED PROBLEMS OR CONCERNS WITH THE PROJECT/ACTIVITY THAT THE COMMUNITY DEVELOPMENT OFFICE COULD PROVIDE ASSISTANCE TO RESOLVE. s :\cp\cd\new\projects\wft\exhbts ,doc EXHIBIT D SUBRECIPIENT REPORT Status Report for Month of 1. SUBRECIPIENT INFORMATION Subrecipient '-. Contact Person Telephone Mailing Address II. NARRATIVE DESCRlPTIONOF ACTIVITY STATUS/MILESTONES: II III. BUDGET STATUS EXPENSES TOTAL AMOUNT REQUESTED ESTlMA TED PAID EXPENSES PAID OUTSTANDING FROM COUNTY ACTIVITY BU DG ET THIS MONTH TO DATE OBLlGA TIONS TO DATE TOTAL IV. NEW CONTRACTS EXECUTED THIS MONTH (also subcontracts - new or not previously reported) Racial! I. White 1, mack Ethnic J. "n,erlun Indian! At..lull Natin NAME OF CONTRACTOR OR AMOUNT OF CONTRACTOR (OR SUB) Code 4,lIi.p.nic CONTRACTOR (OR SUO) S,A.i.nlPaeilic SUOCONTRACTOR CONTRACT 1.0, NUMBER Islander ADDRESS .. ..... . , '-. V. FOR PROJECTS WHICH SERVE A PARTICULAR CLIENTELE: Number of Percent of Total. Number of Households/Persons Assisled (column C) who are: Households! Low and White Dlack American Asian or Female PROJECT Persons Moderale Low Not Hispanic Not Hispanic Indian or Hispanic Paci lie Headed Assisted to Date Income Income Origin Origin Alaskan Native 151 ander Household b c d e f g h I j k II VI. PROBLEM AREAS Submitted by: Date: P ICPlrIlIfORMs\SlJIIRPT DOC EXHIBIT E .. ..... NAME OF ORGANIZATION: FISCAL YEAR 1999-2000 END OF YEAR REPORT Type of service provided: Total number of people served: Total number of groups/sessions performed: TOTAL NUMBER OF HOUSEHOLDS/PERSONS DIRECTLY ASSISTED IN COLUMN "A" No. of . Low and Low White not Black not American Hispanic Asian / Female Household! Moderate Income Hispanic Hispanic Indian / Pacific Headed Persons Income Origin Origin Alaskan Islander Household Assisted Native A B C 0 E F G H I Any other special accomplishments: Signed: s :\cp\cd\new\projects\w1f\exhbls, doc