HomeMy WebLinkAboutAgreement - Indiana Housing and Community Development Authority - Lead Hazard Reduction Demonstration Grant ProgramLEAD HAZARD REDUCTION DEMONSTRATION GRANT PROGRAM AGREEMENT
This is a Subaward
This is Not a Research & Development Award
CFDA #14.905
U.S. Department of Housing and Urban Development
100% Federal Funding
Federal Award No. FAIN: B INLHDO317-17
Federal Award Date: March 1, 2018
FFATA Activity Description: Lead Hazard Reduction
AWARD AGREEMENT NO. LD-018-003
THIS LEAD HAZARD REDUCTION DEMONSTRATION GRANT PROGRAM AGREEMENT (the
"Agreement") is made and entered into by and between the Indiana Housing and Community Development Authority (the
"IHCDA" or "Authority"), a public body corporate and politic of the State of Indiana (the "State"), and the City of South
Bend a Unit of Local Government,( the "Recipient") having a DUNS # of 074327123.
WITNESSETH:
WHEREAS, the Authority is authorized to receive, administer, and disburse funds in order to administer the
undertaking of comprehensive programs to identify and control lead -based paint hazards in eligible privately owned rental
or owner -occupied housing using Lead Hazard Reduction Demonstration Grant Program funds and Healthy Homes
Supplemental funds; and,
WHEREAS, the Recipient has applied to the Authority for an award of such funds, and the Authority desires to
approve and to allocate such funds to the Recipient for the purpose of identifying and controlling lead -based paint hazards
in eligible privately -owned rental or owner -occupied housing in Indiana;
NOW, THEREFORE, in consideration of the following mutual promises, covenants, and conditions contained herein,
and other good and valuable consideration, the sufficiency of which is hereby acknowledged, the parties agree as follows:
1. Incorporation of Recitals. The above recitals are hereby incorporated herein as though set forth in their entirety.
2. The Authority awards the Recipient the sum of Four Hundred Sixty Three Thousand and Nine Hundred Fifty
One dollars 01100 ($463,951.00) (the "Award") for use by the Recipient pursuant to its application, submitted to
IHCDA on May 28, 2018 (the "Application"), exclusively for the purpose and. project outlined therein (the
Project"). A false statement in an application is grounds for denial or termination of an award and possible
punishment, as provided in 18 U.S.C. 1001. The Recipient will also receive the sum of Sixty Five Thousand
dollars 01100 ($65,000.00) (the "Award") in Healthy Homes Supplemental Funding ("HHSF") (Additional
programmatic, statutory and regulatory requirements are attached hereto, made a part hereof, and marked "Exhibit
A" ("Additional Programmatic, Statutory and Regulatory Requirements"). The Recipient has submitted a detailed
budget which has been attached to this Agreement as "Exhibit B" ("Budget"), attached hereto and made a part
hereof.
1. Representations. Warranties, and Covenants of Recipient. The Recipient hereby represents and warrants to the
Authority and covenants with the Authority that:
(a) It shall timely perform or cause to be performed all work specified in its Application;
(b) It shall not request any payment under this Agreement from IHCDA until those funds are actually needed to
pay for eligible expenses;
(c) Its request for any such payment shall be limited to the amount of expenses actually incurred by the Recipient
at that time;
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(d) It shall not expend any pail of the Award for purposes other than the Project or spent[ more of the Award for
any class of items or activities than the amount allocated for such purposes in the appropriate line item of the
Budget, a copy of which is attached hereto, made a part hereof, and marked "Exhibit B";
(e) It shall, from time to time, timely and promptly do each and every act and thing that may be necessary and/or
appropriate to perform its duties and obligations under this Agreement, the Application, the IHCDA CDBG,
HOME and HTF Program Manual (the "Award Manual") the IHCDA Lead Hazard Reduction Demonstration
Grant Work Plan (the "Work Plan") and the IHCDA Lead Hazard Reduction Demonstration Grant Policies
and. Procedures Manual (the "Policy and Procedures");
(f) It shall promptly repay IHCDA for any Lead Funds funds it utilizes for expenses that are deemed "ineligible"
by any of the following: IHCDA, HUD, 24 CFR Part 35, The Residential Lead -Based Paint Hazard Reduction
Act (Title X), Lead Disclosure Rule, The EPA Renovation, Repair and Painting Rule (RRP, 40 CFR 745,
especially subpart E) an audit, the Work Plan, the Policy and Procedures or the Award Manual;
(g) All work and activities authorized and/or contemplated under this Agreement, the Application, and the Project
will be in strict obeyance, compliance, and observance of all applicable laws, rules, regulations, and executive
orders of all Federal, State, and local governments and regulatory bodies, including provisions of the Award
Manual and its application, as from time to time amended;
(h) It shall keep and, upon request, timely submit such records and reports as may be required from time to time
by the Authority or the U.S. Department of Housing and Urban Development ("HUD"), which records shall
include those necessary for fair housing and equal opportunity purposes, and other records reasonably
necessary to assist the Authority in complying with 24 CFR 35
(i) It has not taken and will not take any action or permit any action that is within its control to be taken or fail to
take any action that would impair the Award or the Project. It shall timely prepare all fiscal and management
records required by the Award Manual and/or the Authority that are necessary or appropriate to effectively
administer and/or monitor the Project. It will maintain books, records, documents, and other evidence
pertaining to the Project and all costs and expenses incurred and revenues received under this Agreement in
sufficient detail to reflect all activities undertaken in connection with the Project and all costs, direct and
indirect, of labor, materials, equipment, supplies, services, and other costs of whatever nature, for which
payment is claimed under this Agreement. It shall retain all such records for the greater of three (3) years from
closeout of this Award. Records shall be retained beyond the prescribed period if any of the following occur:
(a) If any litigation, claim, or audit is started before the expiration of the 3-year period, the records must be
retained until all litigation, claims, or audit findings involving the records have been resolved and final action
taken. (b) When the Recipient is notified in writing by HUD or HUD Office of Inspector General, the
cognizant agency for indirect costs, or IHCDA to extend the retention period. (c) Records for real property and
equipment acquired with Federal funds must be retained for 3 years after final disposition. (d) Records for
program income transactions after the period of performance. In some cases the Recipient must report program
income after the period of performance. Where there is such a requirement, the retention period for the records
pertaining to the earning of the program income starts from the end of the Recipient's fiscal year in which the
program income is earned. Copies shall be furnished to the IHCDA at no cost.
(j) In accordance with 2 CFR 200.336, it will provide HUD, the Office of the Inspector General, the Comptroller
General of the United States, and IHCDA, or any of their authorized representatives, access to any documents,
papers, or other records of the Recipient which are pertinent to the Award, in order to make audits,
examinations, excerpts, and transcripts. The right also includes timely and reasonable access to the Recipient's
personnel for the purpose of interview and discussion related to such documents.
(k) It guarantees total satisfactory performance of all work contemplated by this Agreement, and it shall take any
and all action necessary including for purposes of illustration that which is requested by the Authority to
correct or otherwise cure any problems or deficiencies identified by the IHCDA during its monitoring and
evaluation;
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(1) No information or statement furnished by it to the Authority contains, and no report required to be or
otherwise delivered by it to the Authority will contain, any untrue statement of a material fact or will omit to
state a material fact necessary to make such information, statements, or reports not misleading.
2. ' Term of Agreement/Period of Performance. This Agreement shall be effective as of August 31, 2015 (the
"Effective Date") and shall remain in effect until January 29, 2021 ("Expiration Date") except as extended by
written consent of the parties, unless sooner terminated as provided herein. Notwithstanding the foregoing, the
Recipient must expend and disperse the entire amount of the Award within eighteen (18) months of the Effective
Date of this Agreement.
3. Payment Schedule, The Authority shall disburse to the Recipient an amount not in excess of the Award upon: (i)
request for disbursement on form "Claim Voucher" (A-12) properly executed by the Recipient; (ii) receipt of all
proper materials, receipts, and approvals provided herein, together with such other documentation as the Authority
may, from time to time, request; (iii) requested evidence that awarded funds are being expended in proportion to
expenditures of match and leverage; and (iv) appropriate assurance and/or evidence satisfactory to the Authority
that the Recipient is in full and strict compliance with this Agreement and the Project.
NOTE: Any action, review, recommendation, approval, or other activity taken by or on behalf of the Authority
does not expressly or impliedly, directly or indirectly, suggest, represent, or warrant that the Recipient or the
Project is in compliance with applicable statutes, rules, regulations, applications, or other statements. Rather, the
Recipient acknowledges that it is solely responsible for all such matters.
4, Progress Reports. The Recipient shall submit at a minimum quarterly progress reports to the IHCDA upon request.
The report shall be in written form. The progress reports shall serve the purpose of assuring the IHCDA that work
is progressing in line with the proposal or schedule, and that completion can be reasonably assured on the
scheduled date. The report will be submitted to HUD for final approval.
5. Compliance with Laws.
(a) Any action, review, recommendation, approval, or other activity taken by or on behalf of the Authority does
not expressly or impliedly, directly or indirectly, suggest, represent, or warrant that the Recipient or the Project
is in compliance with applicable statutes, rules, regulations, applications, or other statements. Rather, the
Recipient acknowledges that it is solely responsible for all such matters.
(b) The Recipient shall comply with all applicable federal, state and local laws, rules, regulations and ordinances,
and all provisions required thereby to be included herein are hereby incorporated by reference. The enactment
of any state or federal statute or the promulgation of regulations thereunder after execution of this Agreement
shall be reviewed by the IHCDA and the Recipient to determine whether the provisions of this Agreement
require formal modification.
(c) The Recipient and its agents shall abide by all ethical requirements that apply to persons who have a business
relationship with the State as set forth in IC §4-2-6 et seq., IC §4-2-7, et. seq. and the regulations promulgated
thereunder. If the Recipient has knowledge, or would have acquired knowledge with reasonable inquiry, that a
state officer, employee, or special state appointee, as those terms are defined in IC 4-2-6-1, has a financial
interest in the Agreement, the Recipient shall ensure compliance with the disclosure requirements in IC 4-2-6-
10.5 prior to the execution of this Agreement. If the Recipient is not familiar with these ethical requirements,
the Recipient should refer any questions to the Indiana State Ethics Commission, or visit the Inspector
General's website at http://www.in.gov/ig/. If the Recipient or its agents violate any applicable ethical
standards, IHCDA may, in its sole discretion, terminate this Agreement immediately upon notice to the
Recipient. In addition, the Recipient may be subject to penalties under IC §§4-2-6, 4-2-7, 35-44.1-1-4, and
under any other applicable laws.
(d) The Recipient certifies by entering into this Agreement, that neither it nor its principal(s) is presently in arrears
in payment of its taxes, permit fees or other statutory, regulatory or judicially required payments to the State.
Further, the Recipient agrees that any payments in arrears and currently due to the State may be withheld from
payments due to the Recipient. Additionally, further payments may be withheld, delayed, or denied and/or this
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Agreement suspended until the Recipient is current in its payments and has submitted proof of such payment
to the State and the IHCDA.
(e) The Recipient warrants that it has no current or outstanding criminal, civil, or enforcement actions initiated by
the State pending, and agrees that it will inunediately notify the State and the IHCDA of any such actions.
During the term of such actions, the Recipient agrees that IHCDA may delay, withhold, or deny work under
any supplement, amendment or contractual device issued pursuant to this Agreement.
(f) If a valid dispute exists as to the Recipient's liability or guilt in any action initiated by the State or its agencies,
and the IHCDA decides to delay, withhold, or deny funding to the Recipient, the Recipient may request that
funding be continued. The Recipient must submit, in writing, a request for review to the Indiana Department
of Administration ("IDOA") following the procedures for disputes outlined herein. A determination by IDOA
shall be binding on the parties. Any payments that the IHCDA may delay, withhold, deny, or apply under this
Subsection (f) shall not be subject to penalty or interest except as permitted by IC 5-17-5.
(g) The Recipient warrants that the Recipient and its subcontractors, if any, shall obtain and maintain all required
permits, licenses, and approvals, and shall comply with all health, safety, and envirommental statutes, rules, or
regulations in the performance of work activities for the IHCDA. Failure to do so is a material breach and
grounds for immediate termination of this Agreement and denial of further payment by the IHCDA.
(h) The Recipient hereby affirms that if it is an entity described in IC Title 23, it is properly registered and owes
no outstanding reports with the Indiana Secretary of State.
(i) As required by IC 5-22-3-7:
(1) The Recipient and any principals of the Recipient certify that (A) the Recipient, except for de minimis and
nonsystematic violations, has not violated the terms of (i) IC 24-4.7 (Telephone Solicitation Of Consumers),
(ii) IC 24-5-12 (Telephone Solicitations) , or (iii) IC 24-5-14 (Regulation of Automatic Dialing Machines) in
the previous three hundred sixty-five (365) days, even if IC 24-4.7 is preempted by Federal law; and (B) the
Recipient will not violate the terms of IC 24-4.7 for the duration of this Agreement, even if IC 24-4.7 is
preempted by Federal law.
(2) The Recipient and any principals of the Recipient certify that an affiliate or principal of the Recipient and
any agent acting on behalf of the Recipient or on behalf of an affiliate or principal of the Recipient (A) except
for de minimis and nonsystematic violations, has not violated the terms of IC 24-4.7 in the previous three
hundred sixty-five (365) days, even if IC 24-4.7 is preempted by Federal law; and (B) will not violate the
terms of IC 2447 for the duration of this Grant Agreement, even if IC 24-4.7 is preempted by Federal law.
6. Limitations on Expenditures of Program Funds.
(a) The Recipient and other participants in the Program are prohibited from undertaking, committing or expending
HUD or non -HUD hinds on a project or activities under this Agreement (other than activities listed at 24 CFR
58.34, 58.35(b) or 58.22(f), e.g., lead -based paint inspections, risk assessments, and housing related health
hazard assessments) until the Recipient completes an environmental review including the submission, and
I -IUD approval, of a Request for Release of Funds and the recipient's Environmental Certification (both on
Form HUD7015.15).
(b) Funds shall not be obligated or utilized for any activities requiring a release of funds by the State under the
Environmental Review Procedures applicable to the Lead program set forth in 24 C.F.R. farts 50 and 58, and
any successor statute or regulation, until such release is issued in writing.
7. Termination,• Cancellation of Fundin .
(a) Termination.
The Authority may immediately suspend or terminate this Agreement if the Recipient fails to comply with any
material term of the Agreement.
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(b) For Convenience. This Agreement may be terminated, in whole or in part, by the Authority whenever, for any
reason, the Authority determines that such termination is in the best interest of the Authority. Termination
shall be effected by delivery to the Recipient of a Termination Notice, specifying the extent to which such
termination becomes effective. The Recipient shall be compensated for completion of activities properly
performed prior to the effective date of termination. The Authority will not be liable for activities performed
after the effective date of termination.
(c) Funding Cancellation. When the Executive Director of IHCDA or the Director of the State Budget Agency
makes a written determination that funds are not available to support continuation of performance of this
Agreement, the Agreement shall automatically terminate. Any determination by the Executive Director of
IHCDA or the Director of the State Budget Agency that funds are not appropriated or otherwise available to
support continuation of performance shall be final and conclusive.
(d) Cross -Default. This Agreement may be suspended and/or terminated immediately if the Recipient has
committed fraud or has misused or misappropriated funds received under this Agreement or another agreement
between the Recipient and II-ICDA. In this event IHCDA may de -obligate and/or re -distribute all or any
portion of this award to another recipient. This section shall survive the termination or expiration of this
Agreement, Further, Recipient's breach or default of other agreements or obligations related to the Project
shall constitute a material breach of this Agreement.
(e) Effect of Termination. Upon expiration or termination of this Agreement for any reason, the Recipient shall
transfer to the Authority any unexpended funds on hand and any accounts receivable attributable to the use of
the Award.
8. Insurance and Indemnification.
(a) Insurance. During the Term, the Recipient shall obtain and maintain, at its expense, with an insurer acceptable
to IHCDA, comprehensive general liability coverage, including contractual coverage, with minimum liability
limits of $500,000 per occurrence and $1,000,000 in the aggregate unless additional coverage is required by
IHCDA. The Recipient shall deliver to the IHCDA a certificate of insurance as soon as practicable upon
execution of this Agreement evidencing coverage or the IHCDA shall have the right to terminate this
Agreement immediately.
(b) Indemnification. The Recipient shall indemnify, defend, and hold harmless the IHCDA, its directors, officers,
employees, and agents of and from any and all claims, losses, damages, or expenses (including reasonable
attorneys' fees) arising out of or in any way related to (a) any breach or alleged breach by the Recipient of any
provision of this Agreement or the Application or any material inaccuracy of any representation or warrant
made by it herein, (b) any act or omission by the Recipient, its employees, agents, representatives or affiliates,
directly or indirectly, related to its performance of this Agreement constituting negligence, recklessness or
willful misconduct; and (c) any alleged failure on the part of the Recipient, its employees, agents,
representatives or affiliates to comply with any federal, state and local laws and regulations. The Authority
shall not provide such indemnification to the Recipient. This subsection shall survive the termination or
expiration of this Agreement.
9. Notice to Parties. Notice shall be deemed to have been given under this Agreement whenever any notice,
statement, or other communication shall be delivered in person, or sent via overnight delivery service maintaining
records of receipt to the address below, unless otherwise requested in writing:
(a) Notices to the Recipient shall be sent to:
City of South Bend
227 West Jefferson Avenue- Suite 1400 N
South Bend, IN 46601
Attention: IHCDA Award Administrator
(b) Notices to the IHCDA shall be sent to:
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Indiana Dousing and Community Development Authority
30 South Meridian Street, Suite 900
Indianapolis, IN 46204
Attention: CDBG
(c) With a copy to:
David Stewart, General Counsel
Indiana Housing and Community Development Authority
30 S. Meridian Street, Suite 900
Indianapolis, IN 46204
(d) Awarding Official:
IHCDA
J. Jacob Sipe, Executive Director
30 S. Meridian Street 900
Indianapolis, IN
JSipe(iDiheda.Mizov
The parties may change the foregoing notice addresses by providing notice of such change to the other party in
accordance with this Section 11.
10. Lobbying Activities. Pursuant to 5 U.S.C. § 1502 and 31 U.S.C. § 1352 (and any applicable successor sections),
and any regulations promulgated thereunder, the Recipient hereby certifies that no Federally appropriated funds
have been paid or will be paid by or on behalf of the Recipient to any person for influencing or attempting to
influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an
employee of a member of Congress, in connection with the awarding of any Federal contract, the making of any
Federal award, the making of any Federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment to, or modification of any Federal contract, award, loan, or cooperative
agreement. 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 an employee of a member of Congress, the Recipient must complete and submit
Standard Form-LLL, "Disclosure Form to Report Lobbying", in accordance with its instructions.
11. Non -Discrimination Clause. Non -Discrimination Clause. Pursuant to the Indiana Civil Rights Law, specifically
including Indiana Code § 22-9-1-10, and in keeping with the purposes of the federal Civil Rights Act of 1964, the
Age Discrimination in Employment Act, and the American with Disabilities Act, the Recipient covenants that it
shall not discriminate against any employee or applicant for employment relating to this Agreement with respect to
hire, tenure, terms, conditions or privileges of employment or any matter directly or indirectly related to
employment because of the employee or applicant's race, age, color, religion, sex, disability, national origin,
ancestry, or status as a veteran, or any other characteristic protected by federal, state, or local law ("Protected
Characteristics"). Furthermore, the Recipient certifies compliance with applicable federal laws, regulations, and
executive orders prohibiting discrimination based on the Protected Characteristics in the provision of services. The
Recipient understands that IHCDA is a recipient of federal funds, and therefore, where applicable, the Recipient
and its subcontractors agree to comply with requisite affirmative action requirements, including reporting pursuant
to 41 CPR. Chapter 60, as amended and Section 202 of Executive Order 11246. The Recipient will be required to
document compliance with all nondiscrimination laws, executive orders, and regulations.
12. Drug -Free Workplace Certification. This clause is required by Executive Order 90-5 and applies to all individuals
and private legal entities who receive grants or contracts from State agencies. This clause was modified in 2005 to
apply only to Recipient's employees within the State of Indiana and cannot be further modified, altered or changed.
As required by Executive Order No. 90-5, April 12, 1990, issued by the Governor of Indiana, the Recipient hereby
covenants and agrees to make a good faith effort to provide and maintain a drug -free workplace. Recipient will
give written notice to IHCDA within ten (10) days after receiving actual notice that the Recipient, or an employee
of the Recipient in the State of Indiana, has been convicted of a criminal drug violation occurring in the workplace.
False certification or violation of the certification may result in sanctions including, but not limited to, suspension
of grant payments, termination of the Grant and/or debarment of grant opportunities with the State of Indiana for
up to three (3) years.
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In addition to the provisions of the above paragraphs, if the total amount set forth in this Agreement is in excess of
$25,000.00, the Recipient certifies and agrees that it will provide a drug -free workplace by:
(a) Publishing and providing to all of its employees a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the
Applicant's workplace and specifying the actions that will be taken against employees for violations of such
prohibition; and
(b) Establishing a drug-fi-ee awareness program to inform employees about (1) the dangers of drug abuse in the
workplace; (2) the Applicant's policy of maintaining a drug-fi•ee workplace; (3) any available drug counseling,
rehabilitation, and employee assistance programs; and (4) the penalties that may be imposed upon an employee
for drug abuse violation occurring in the workplace;
(c) Notifying all employees in the statement required by subparagraph (a) above that as a condition of continued
employment the employee will (1) abide by the terms of the statement; and (2) notify the employer of any
criminal drug use conviction for a violation occurring in the workplace no later than five (5) days after such a
conviction;
(d) Notifying in writing the contracting State Agency and the Indiana Department of Administration within ten
(10) days after receiving notice fi•om an employee under subdivision (c)-(2) above, or otherwise receiving
actual notice of a conviction;
(e) Within thirty (30) days after receiving notice under subdivision (c)-(2) above of a conviction, imposing the
following sanctions or remedial measures on any employee who is convicted of drug abuse violations
occurring in the workplace: (1) take appropriate personnel action against the employee, up to and including
termination; or (2) require such employee to satisfactorily participate in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State or local health, law enforcement, or
other appropriate agency; and
(f) Making a good faith effort to maintain a drug -free workplace through the implementation of subparagraphs (a)
through (e) above.
13. Inde ndent Contractor. All parties hereto, in the performance of this Agreement, will be acting in an individual
capacity and not as agents, employees, partners, joint venturers, or associates of one another. The employees of
one party shall not be deemed or construed to be the employees or agents of the other parties for any purpose
whatsoever. Except for as set forth in Section 10(b), neither party will assume liability for any injury to any
persons, or any damage to any property, arising out of the acts or omissions of the agents, employees, or
subcontractors of the other party.
14. Work Standards. The Recipient shall each execute its responsibilities by following and applying at all times the
highest professional and technical guidelines and standards. If the Authority becomes dissatisfied with the work
product of or the working relationship with those individuals assigned to perform activities pursuant to this
Agreement, the Authority may request in writing the replacement of any or all such individuals, and the Recipient
shall grant such request
15. Assurances and Certifications. The Recipient agrees to comply with the "Assurances and Certifications" set forth
in Exhibit C. "Those "Assurances and Certifications" are fully incorporated herein, and made a part hereof by
reference. Any material inaccuracy of any representation or warranty contained therein shall constitute a material
breach of this Agreement, for which the Authority may terminate this Agreement. The Recipient further certifies
that it will comply with the requirements and standards of all applicable provisions in the following:
(a) Post federal award requirements in 2 CFR 200 Subpart D, Cost principles in 2 CFR 200 Subpart E, and Audit
Requirements set forth in 2 CFR 200 Subpart F; and
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16. Audits, The Recipient shall submit to an audit of fiends paid through this Agreement and/or an onsite monitoring
review of the Project by IHCDA or its designee.
(a) If Recipient expends $750,000 or more in federal awards during the Recipient's fiscal year it must submit
its single audit to the IHCDA within the earlier of thirty (30) days after receipt of the auditor's report(s),
or nine (9) months after the end of the audit period. The Recipient must also submit its audit to the
Federal Audit Clearinghouse.
If the Recipient expends less than $750,000 in federal awards it must submit its audited financial
statements or 990 (IRS Form 990, Return of Organization Exempt From Income Tax) to IHCDA within
the earlier of thirty (30) days after receipt of the auditor's report(s), or nine (9) months after the end of the
audit period.
(b) Any auditor performing a single or program specific audit for the Recipient must comply with 2 CFR
200.501.
(c) Sanctions: If Recipient does not adhere to the policies referenced in subparagraphs A and B of this
section, at IHCDA's sole discretion, it may take appropriate action using sanctions such as:
(1) Withholding a percentage of this funding until the audit is completed satisfactorily;
(2) Withholding or disallowing claims;
(3) Suspending all funding from any IHCDA awards until the audit is conducted; or
(4) Terminating this Agreement.
17. Federal Funding Accountabilfty and Transparency Act of 2006 ("FFATA" . In accordance with 2 CFR
200.300(b), FFATA reporting requirements will apply to any funding awarded by IHCDA under this Agreement in
the amount of $25,000 or greater. The Recipient, as a sub -recipient, must provide any information needed
pursuant to these requirements. This includes entity information, the unique identifier of the Recipient, the unique
identifier of Recipient's parent, and relevant executive compensation data, if applicable (see subsection C below
regarding executive compensation data).
A. Data Universal Numberin S stem DUNS number
Pursuant to FFATA reporting requirements and in order to receive funding under this Agreement, the Recipient
shall provide IHCDA with a valid Dun & Bradstreet ("D&B") Data Universal Numbering System ("DUNS")
number that identifies the Recipient. Accordingly, the Recipient shall register for and obtain a DUNS number
within fifteen (15) days of execution of this Agreement if it does not currently have a DUNS number. A DUNS
number may be requested from D&B by telephone (currently 866-705-5711) or the Internet (currently at
http://fedg ov. dnb. r,o Wwebfurm).
B. System for Award Management SAM
The Recipient shall register in the System for Award Management ("SAM"), which is the primary registrant
database for the U.S. Federal Government, and shall enter any information required by FFATA into the SAM,
update the information at least annually after the initial registration, and maintain its status in the SAM through the
Expiration Date of this Agreement. Information regarding the process to register in the SAM can be obtained at
https://www.sam.goy/ ortal/ ublic/SAM/.
C. Federal Awardee Performance and Integrity Information System (FAPIIS)
The Recipient shall register in the Federal Awardee Performance and Integrity Information System ("FAPHS")
which is a database to track contractor misconduct and performance. Information regarding FAPIIS can be
obtained at https•//www,fapiis.gov/fapiis/index.aetion.
D. Executive Coln ensation
The Recipient shall report the names and total compensation of the five (5) most highly compensated officers of
Recipient in SAM if the Recipient in the preceding fiscal year received eighty percent (80%) or more of its annual
gross revenues from Federal contracts and Federal financial assistance (as defined at 2 CFR 170.320) and
$25,000,000 or more in annual gross revenues fiom Federal contracts and federal financial assistance (as defined at
2 CFR 170.320); and if the public does not have access to this information about the compensation of the senior
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executives of the entity through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act
of 1934 (15 U.S.C. §§ 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986. The Recipient may
certify that it received less than eighty percent (80%) of annual gross revenues from the federal government,
received less than $25,000,000 of its annual gross revenues from the federal government, already provides
executive compensation to the Securities Exchange Commission, or meets the Internal Revenue Code exemption,
and will not be required to submit executive compensation data into the SAM under FFATA, provided, that the
Recipient shall still register and submit the other data requested.
18. Indirect Cost Rate. According to 2 CFR 200.414(f), the Recipient may charge a de minimis rate of 10% of
modified total direct costs (MTDC). As described in 2 CFR 200.403, Factors affecting allowability of costs, costs
must be consistently charged as either indirect or direct costs, but may not be double charged or inconsistently
charged as both. If chosen, this methodology once elected must be used consistently for all Federal awards until
such time as the Recipient chooses to negotiate a rate, which the Recipient may apply to do at any time.
A proposal to establish a cost allocation plan or an indirect (F&A) cost rate, whether submitted to a Federal
cognizant agency for indirect costs or maintained on file by the Recipient, must be certified by the Recipient using
the Certificate of Cost Allocation Plan or Certificate of Indirect Costs as set forth in Appendices III through VII,
and Appendix TX in 2 CFR part 200. The certificate must be signed on behalf of the Recipient by an individual at
a level no lower than vice president or chief financial officer of the Recipient.
19. Employment Eligibility Verification. As required by IC §22-5-1.7, the Contractor swears or affirms under the
penalties of perjury that the Contractor does not knowingly employ an unauthorized alien.
The Contractor further agrees tbat:
The Contractor shall not knowingly employ or contract with an unauthorized alien. The Contractor shall not retain
an employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
20. GoverningLaw. This Agreement shall be construed and governed in accordance with the laws of the State of
Indiana.
21. Headings. The headings and subheadings herein are for the convenience of the parties hereto and shall have no
legal effect upon the construction of this Agreement.
22. Non -Waiver. No waiver, forbearance, or failure by any party of its right to enforce any provision of this
Agreement shall constitute a waiver or estoppel of such parry's right to enforce such provision in the future,
23. Publiefty. The parties shall cooperate with respect to all public statements regarding the subject matter of this
Agreement. The parties agree that any publicity release or other public reference, including but not limited to
media releases and informational pamphlets relating to the Project and any services funded under this Agreement,
will clearly state that all activities and services are provided without regard to race, age, color, religion; sex,
disability, national origin, ancestry, or status as a veteran.
24. Severability. The invalidity of any provision of this Agreement shall not invalidate the remaining provisions of this
Agreement.
25, Exhibits. Exhibits A, B, C are attached hereto are fully incorporated herein
26. Order of Precedence. Any inconsistency or ambiguity in this Agreement shall be resolved by giving precedence in
the following order: (1) the Agreement, (2) the Exhibits prepared by the IHCDA, (3) the Award Manual/Policy and
Procedure, Workplan, (4) the Application, and (5) the Exhibits prepared by the Recipient.
LEAD- CITY of SOUTH BEND LD-01 S-003
Page 9 of 23
Non -Collusion and Acceptance
The undersigned attests, subject to the penalties for pei jury, that the undersigned is the Recipient, or that the undersigned is
the properly authorised representative, agent, member or officer of the Recipient. Further, to the undersigned's knowledge,
neither the undersigned nor any other member„ employee, representative, agent or officer of the Recipient, directly or
indirectly, has entered into or been offered any sure of money or other consideration for the execution of this Agreement
other than that which appears upon the face hereof. Furthermore, if the undersigned has knowledge that a state
officer, employee, or special state appointee, as those terms are defined in IC 4-2-6-1, has a financial interest in the
Agreement, the Recipient attests to compliance with the disclosure requirements in IC 4-2-6-10.5,.
In Witness Whereof, Recipient and II-ICDA have,
Agreement. The parties, having read and understood
signatures dated below hereby agree to the terms thereof
City of South BendAI?PUQ'VVtn
By._.. —
Printed N
bagrd of Work,4
Grant Number LD Ql
CFDA i''i`urnber 14.90.'
through their duly authorized representatives, entered into this
the foregoing terms of this Agreement, do by their respective
Indiana housing and Community Development Authority:
By: ---
Printed Name: L Jacob SiPe
Title: Executive Director
T.,HA CITY .11011TH BEND I,D-t7I R 003
Pafze 10 of23
EXHIBIT A
ADDITIONAL PROGRAMMATIC, STATUTORY AND REGULATORY REQUIREMENTS
Agreement Number: LD-018-003
Recipient: City of South Bend
Funding Source/Activity Type: LHRD
Tire award recipient is bound by the contents of the Indiana Housing and Community Development Authority's
(IHCDA's) Lead Hazard Demonstration Grant application package, Manual,, Red Notices, FAQs, the Recipient's
approved application, and any other IHCDA policy, directives, or memoranda that may be published from time to
time.
AGREEMENT EXECUTION
The recipient must execute and return this Agreement to the Indiana Housing and Community Development Authority
(IHCDA) no later than October 1, 2018.
HEALTH HOMES SUPPLEMENTAL FUNDS
Healthy Homes Supplemental funds are intended for use in units where LHRD funds are used. Healthy Homes
Supplemental funds may be used only in homes also receiving HUD -funded lead hazard control work (interim controls or
abatement). The Recipient must use an assessment/inspection tool that assesses for all 29 hazards identified in the Healthy
Homes Rating System (HHRS) for assessing, prioritizing and repairing the identified health and safety hazards within those
units. Healthy Homes Supplemental funds may not be used to pay for salary or fringe benefits.
RECIPIENT MUST WORK TO ACCOMPLISH THE FOLLOWING OBJECTIVES
A. Maximize the number of children under the age of six years protected from lead poisoning and the number of
housing units where lead hazards are controlled;
B. Target lead hazard control efforts in housing units where children are at greatest risk of lead poisoning, especially
children currently residing in low-income and minority families, to reduce elevated blood lead levels in children
under the age of six years;
C. Promote cost-effective lead hazard control methods and approaches that can be replicated, maintained, and
sustained;
D. Build local capacity to safely and effectively address lead hazards during lead hazard control and renovation,
remodeling, and maintenance activities by integrating lead -safe work practices;
E. Promote integration of this grant program with other local programs that address housing related health and safety
hazards;
F. Obligation to affirmatively further fair housing. Note that besides being an "objective" of this NOFA, the
obligation to affirmatively further fair housing is also a civil rights related program requirement;
G. Develop a comprehensive community -based approach to address lead hazards in housing by mobilizing public and
private sector resources including grassroots community -based non-profit and faith -based organizations;
H. Promote collaboration, data sharing, and targeting between health and housing departments;
I. Establish a detailed process that will facilitate lead -safe units to be affirmatively marketed, and priority given, to
families with young children;
J. Ensure to the greatest extent feasible that job training, employment, contracting, and other economic opportunities
generated by this grant will be directed to low- and very -low income persons, particularly those who are recipients
of government assistance for housing, and to businesses that provide economic opportunities to low- and very low-
income persons in the area in which the project is located. For more information, see 24 CFR 135; and
K. Further environmental justice, the fair treatment and meaningful involvement of all people within target
communities regardless of race, color, national origin, disability, or income with regarding to the development,
implementation, and enforcement of environmental laws, regulations, and policies.
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L, Comply with Section 504 of the Rehabilitation Act of 1973 ("Section 504") and its implementing regulations at 24
CFR 8, and Titles II and III of the Americans with Disabilities Act. Each of these prohibits discrimination based on
disability.
BLOOD LEAD TESTING
Recipient must test each child under the age of six years who resides in a housing unit that is to have lead hazard control
work done for an elevated blood lead level within six months preceding the lead hazard control work, unless the child's
parent or legal guardian chooses not to have the child tested. You must refer any child with an elevated blood lead level for
appropriate medical follow-up. The standards for blood lead testing are described in the U.S. Centers for Disease Control .
and Prevention (CDC) publications Preventing Lead Poisoning in Young Children (1991), and Screening Young Children
for Lead Poisoning: Guidance for State and Local Public Health Officials (1997). See also, the CDC Response to Advisory
Committee on Childhood Lead Poisoning Prevention Recommendations in "Low Level Lead Exposure ITarms Children: A
Renewed Call of Primary Prevention" (2012) available at
http://www.ede.gov/nceh/lead/ACCLPP/CDC_Response Lead Exposure Rees.pdf
COMPLIANCE WITH HUD REGULATIONS AND GUIDELINES
The Recipient must conduct lead hazard evaluation and control work in compliance with HUD's Lead Safe Housing Rule,
the current HUD Guidelines for the Evaluation and Control of Lead -Based Paint Hazards in Housing (current HUD
guidelines;
http://portal.hud.gov/hudportal/HUD?src=/program_ offices/healthy_homes/]bp/hudguidelines/), and applicable federal,
state and local regulations and guidance, including, but not limited to the EPA's Renovation, Repair, and Painting (RRP)
Rule (found within 40 CFR 745; see
bttp://www2,epa ,gov/lead/renovation-repair-and-paintin -pro rg at_n/).
PROHIBITED PRACTICES
The Recipient is not permitted to engage in practices prohibited under HUD's Lead Safe Housing Rule at 24 CPR 35,140,
EPA's RRP Rule at 40 CFR 745.83(a)(3), or EPA's lead abatement rule at 40 CFR 745.227(e)(6),
PROCUREMENT REQUIREMENTS
Recipient must procure all goods and services must through a competitive process. Recipients must follow federal
procurement requirements as defined in 2 CFR 200.317-326, as applicable.
CLOSEOUT
A. The Recipient must submit, no later than the Expiration Date, all financial, performance information and other
information as required by the terms and conditions this Agreement and IHCDA's Administrative Plan.
B . The closeout of a Federal award does not affect any of the following:
1. The right of IHCDA to disallow costs -and recover funds on the basis of a later audit or other review.
2. The obligation of the Recipient to return any funds due as a result of later refunds, corrections, or other
transactions including final indirect cost rate adjustments.
3. Audit requirements in subpart F of 2 CFR part 200.
4. Records retention requirements as set forth herein.
FORM OF ASSISTANCE
Homeowner: The Recipient must provide this award as a grant directly to the beneficiary.
Rental: The recipient must provide this award as a forgivable loan directly to the landlord. A lien and restrictive covenant
will be executed against every multi -family or rental property receiving LHRD grant funds. Upon occurrence of any of the
following events during the three year Affordability Period, the entire sum secured by the lien, without interest, shall be due
and payable by the property owner upon demand. Repayment may be demanded upon: (1) Transfer or conveyance of the
real estate by deed, land contract, lease, or otherwise, during the Affordability Period; (2) Commencement of foreclosure
proceedings by any mortgagee (or deed in lieu of foreclosure), within the Affordability Period; (3) Units not being used as a
residence by a qualifying tenant or not leased according to the LHRD Participation Agreement. The Recipient must execute
and record a lien and restrictive covenant agreement prepared by IHCDA.
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Persons who, as a result of national origin, do not speak English as their primary language and who have limited ability to
speak, read, write, or understand English ("limited English proficient persons" or "LEP") may be entitled to language
assistance under 'Title VI in order to receive a particular service, benefit, or encounter. In accordance with Title VI of the
Civil Rights Act of 1964 (Title VI) and its implementing regulations, the Recipient agrees to take reasonable steps to ensure
meaningful access to activities funded with CDBG funds by LEP persons. Any of the following actions could constitute
"reasonable steps", depending on the circumstances: acquiring translators to translate vital documents, advertisements, or
notices, acquiring interpreters for face to face interviews with LEP persons, placing advertisements and notices in
newspapers that serve LEP persons, partnering with other organizations that serve LEP populations to provide
interpretation, translation, or dissemination of information regarding the project, hiring bilingual employees or volunteers
for outreach and intake activities, contracting with a telephone line interpreter service, etc.
TEMPORARY RELOCATION
Participation in the LHRD program is voluntary, so participants are not eligible for permanent relocation assistance. I -IUD
expects that the lead hazard control work and temporary relocation will take 10 days or less. Assisting with reasonable costs
of temporary relocation for those persons required to vacate housing while participating in this voluntary maintenance
program for lead hazard reduction is an eligible activity. Occupants must be treated fairly and equitably, in particular,
regarding removing participation barriers created by relocation requirements if housing must be vacated while lead hazard
reduction measures are being conducted. Such tenant -occupants are entitled to receive temporary relocation assistance
where applicable pursuant to the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
(URA), 42 U.S.C. §§ 4601-4655, as described in regulations at 49 CFR 24.2(a)(9)(ii)(D) and the corresponding Appendix
A to Part 24. (These regulations can be accessed from the Government Publishing Office website at
http://www.gpoaccess.gov/efr/indox.html.) Owner -occupants temporarily relocating while lead hazard reduction measures
are conducted pursuant to a program described in this NOFA are not entitled to URA relocation assistance. When tenant
occupants with physical disabilities are temporarily relocated, they must receive relocation assistance. When tenant
occupants with physical disabilities are temporarily relocated, they must be offered housing that can be approached, entered,
and used by persons with physical disabilities, For additional information on relocation requirements, see the HUD
Handbook 1378 (Real Estate Acquisition and Relocation Policy and Guidance).
INELIGIBLE COSTS AND ACTIVITIES.
Recipient may not use the Awards for any of the following activities_
A. Purchase of real property.
B. Purchase or lease of equipment having a per -unit cost in excess of $5,000, except for the purchase or lease of up to
two X-ray fluorescence analyzers to be used exclusively by the grant program.
C. Chelation or other medical treatment costs, including case management, related to children with elevated blood
lead levels (EBLs). Non-federal funds used to cover these costs may not be counted as part of the matching
contribution.
D. Lead hazard evaluation or control activities in public housing, project -based Section 8 housing, housing for the
elderly or persons with disabilities (except if a child under age 6 resides or is expected to reside in such a housing
unit), zero bedroom housing units, or housing built after 1977).
E. Lead hazard evaluation or control activities in housing covered by a pending or final I -IUD, EPA, and/or
Department of Justice settlement agreement, consent decree, count order or other similar action regarding violation
of the Lead Disclosure Rule (24 CFR part 35, Subpart A, or the equivalent 40 CFR part 745,subpart F), or by I -IUD
regarding the Lead Safe Housing Rule (24 CFR part 35, subparts BR).
F. Activities that do not comply with the Coastal Barrier Resources Act (16 U.S.C. § 3501).
G. Lead -hazard control or rehabilitation of a building or manufactured home that is Iocated in an area identified by the
Federal Emergency Management Agency (FEMA) under the Flood Disaster Protection Act of 1973 (42 U.S.C. §§
4001— 4128) as having special flood hazards.
H. Demolition of housing units or detached buildings.
TRAINED AND CERTIFIED PROFESSIONALS
Funded activities must be conducted by firms certified for, and persons qualified for, the activities according to 24 CFR part
35, subparts B--R (possessing certification as risk assessors, inspectors, abatement supervisors, abatement workers, or
sampling technicians (clearance inspections); or certified renovator (for workers and supervisors performing non -abatement
work), as applicable to each scope of work. Any abatement activities conducted under this Award requires a certified
abatement firm, certified abatement supervisor, and certified abatement worker credentialing. Each certified person must
work for an appropriately certified firm, e.g., a certified risk assessment, certified inspection, certified abatement or certified
LEAD- CITY of SOUTH BEND LD-018-003
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renovation firm, as applicable. EPA RRP certification is NOT sufficient for work under this Award that includes measures
designed to permanently eliminate lead -based paint hazards including but not limited to window and substrate remove and
replacement activities.
LEAD -BA PAINT AND L)rAD-BASED PAINT HAZARD IDENTIFICATION
A complete lead -based paint inspection and lead hazard risk assessment, including either separate reports or a combined
report are required for all properties. Presumption of the presence of lead -based paint or lead -based paint hazards is not
permitted. Paint inspections and risk assessments must follow the procedures as defined in the HUD Guidelines for the
Evaluation and Control of Lead -Based Paint Hazards in Housing and as defined by the policies of the Lead Hazard
Reduction Demonstration Grant Program. Refer to Policy Guidance 2013-01 on the OLHCHH website
http://poital.hud.gov/hudportal/HUD?src=/program_offices/healthy_iomes/lbp/pg for additional requirements.
OWNER NOTIFICATION
All lead -based paint testing results, summaries of lead -based paint hazard control treatments, and clearances must be
provided to the owner of the unit, together with a notice describing the owner's legal duty to disclose the results to tenants
and buyers (see 24 CPR 3 5.8 8 of the Lead Disclosure Rule). The Recipient must ensure that this information is provided in
a manner that is effective for persons with disabilities (24 CFR 8.6) and those persons with limited English proficiency
(LEP) will have meaningful access to it (see Executive Order 13166). Grant files must contain verifiable evidence of
providing lead hazard evaluation and control reports to owners and tenants, such as a signed and dated receipt.
TESTING
All testing, sampling and laboratory analysis for lead must comply with the Lead Safe Housing Rule and conform to the
current HUD Guidelines, the EPA lead hazard standards at 40 CFR part 745, and federal, state, or tribal regulations
developed as paint of the appropriate contractor certification program, whichever is most protective of children. All
laboratory analyses conducted on paint chips, soil and/or dust samples must be performed by an environmental laboratory
recognized by EPA under the National Lead Laboratory Accreditation Program pursuant to the Toxic Substances Control
Act (15 U,S.C. 2685) (See the list or laboratories at www.epa.gov/lead/national-lead-laboratory-accreditation-program-list).
CONTROLIELIMINATION STRATEGIES
All lead -based paint hazards identified in housing units and in common areas of multifamily housing enrolled in this grant
program must be controlled or eliminated by either of the following strategies or a combination of the two methods below
within 10 days or less:
A. 'Interim Controls
In accordance with the current HUD Guidelines, interim controls of lead -based paint hazards including lead -
contaminated dust and soil in housing must include specialized cleaning techniques to address lead dust.
B. Abatement
Abatement means any set of measures designed to permanently eliminate lead -based paint hazards in accordance
with standards established by the EPA. Abatement includes the removal of lead -based paint and lead
contaminated dust, the permanent containment or encapsulation of lead -based paint, the replacement of
lead painted surfaces or fixtures, and the removal or covering of lead contaminated soil; and all
preparation, cleanup, disposal, and post -abatement clearance testing activities associated with such
measures.
LEAD -BASED PAINT
The Lead -Based Paint Poisoning Prevention Act (-4846), the Residential Lead -Based Paint Hazard Reduction Act of 1992
(42 U.S.C_§ 4851-4856), and implementing regulations in 24 CFR part 35, subparts A, B, H, 7, IC, M, R, and 40 CFR 745
apply to all housing occupied by program participants. Lead -based paint requirements apply to dwelling units built prior to
1978 that are occupied or can be occupied by families with children under six years of age, excluding zero bedroom
dwellings. Accordingly the Recipient must ensure that the following steps are being taken:
1. Provision of all prospective families with "Protect Your Family from Lead in Your Home",
2. Disclosure of ]crown lead -based paint hazards to prospective tenants before the lease is signed,
3. Performance of a risk assessment for deteriorated paint,
4. Stabilization of deteriorated painted surfaces and performance of hazard reduction activities,
5. Notification of tenants each time such an activity is performed,
1
LEAD- CITY of SOUTHI BE] TD Paaceae [ of 4 of 2
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6, Conducting all work in accordance with HUD safe practices,
7. Maintaining records concerning paint stabilization by owners of deteriorated paint.
8. Performing clearance examinations after paint stabilization and before re -occupancy.
9. Performing ongoing lead -based paint maintenance when there is an ongoing relationship with HUD.
10. If the Recipient is notified by a public health department or other medical health care provider, or verifies
information fi•om a source other than a public health department or medical health care provider, that a child of
less than 6 years of age, living in an HOPWA assisted unit has been identified as having an environmental
intervention blood lead level ("EIBLL"), the Recipient must complete a risk assessment of the dwelling unit.
The risk assessment must be completed in accordance with program requirements, and the result of the risk
assessment must be immediately provided to the owner of the dwelling unit. In cases where the public health
department has already completed an evaluation of the unit, this information must be provided to the owner. .
11. Maintaining records of actions taken concerning a child with an EiBLL in a covered unit,
12, As part of ongoing maintenance asking each family to report deteriorated paint.
WASTE DISPOSAL
The Recipient must handle waste disposal according to the requirements of the appropriate local, state, and federal
regulatory agencies, and the HUD Guidelines. The HUD Guidelines are available at
http://portal.hud.gov/hudpoi-taldlUD?src=/program- offices/healthy_homesllbp/hudguidelines.
WORKER PROTECTION PROCEDURES
The Recipient must observe the procedures for worker protection established in the current HUD Guidelines, as well as the
requirements of the Occupational Health and Safety Administration (OSHA) (in particular, 29 CFR 1910.1025, Lead,
and/or 29 CFR 1926.62, Lead Exposure in Construction, as applicable), or the state or local occupational safety and health
regulations, whichever are most protective.
CITIZEN PARTICIPATION
The Recipient should use its best effort to work with all residents of affected areas, especially communities traditionally
marginalized from planning processes. In seeking public participation, the Recipient must ensure that all communications
are provided in a manner that is effective for persons with hearing, visual, and other communications -related disabilities
consistent with Section 504 of the Rehabilitation Act of 1973 and, as applicable, the Americans with Disabilities Act. In
addition, Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000(d) and Executive Order 13166 require that grantees take
responsible steps to ensure meaningful access to services, programs, and activities by persons with Limited English
Proficiency (LEP persons).
COMPLIANCE WITH SECTION 504 OF THE REHABILITATION ACT.
Facilities where program participants come for assistance (e.g., for intake and enrollment in the program), training or
education, must be held in facilities that are accessible to persons with disabilities in accordance with Section 504 of the
Rehabilitation Act and its implementing regulations at 24 CFR Part 8, and with Titles II and III of the Americans with
Disabilities Act, as applicable.
COOPERATION WITH RELATED RESEARCH AND EVALUA"IJON
The Recipient must cooperate fully with any research or evaluation sponsored by HUD or another government agency
associated with this Award, including preservation of project data and records and compiling requested information in
formats provided by the researchers, evaluators or HUD. This may include the compiling of certain relevant local
demographic, dwelling unit, and participant data not contemplated in the original proposal. Participant data must be subject
to the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HWAA), HIPAA and the Privacy
Rule can be found at http://www.hhs.gov/ocr/privacy/. For the program in this NOFA, HUD does not expect research to be
conducted that could affect human subjects.
SECTION 3 REQUIREMENTS
Section 3 of the Housing and Urban Development Act of 1968 (12 U.S.C. § 1701u) is applicable to the Award. If the
Recipient receives awards exceeding $200,000 it is required to comply with Section 3, If the Recipient plans to hire any
new employees or award contracts to carry out the Award, it must comply with the Section 3 requirements found at 24 CFR
135,32. Additionally, if the Recipient, any contractor, subcontractor or sub -grantee receiving contracts under the grant
totaling more than $100,000 must comply with the Section 3 requirements for any new training, hiring or sub -contracting
opportunities provided under those contracts.
LEAD- CITY of SOUTH BEND LD-018-003
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ENSURING THE PARTICIPATION OF SMALL DISADVANTAGED BUSINESS AND WOMEN -OWNER
BUSINESS
State, local, and Indian tribal governments are required by to take all necessary affirmative steps in contracting for the
purchase of goods or services to assure that minority firms, women -owned business enterprises, and labor surplus area firms
are used whenever possible or as specified in the Program NOFAs. Nonprofit recipients of assistance (are required by 2
CFR 200.321 to make positive efforts to utilize small businesses, minority -owned firms, and women's business enterprises,
and Labor Surplus Area Firms whenever possible MBE/WB).
FAIR HOUSING
The Recipient must take steps to affirmatively further fair housing; and when gathering public input, planning, and
implementing housing related activities, will include participation by neighborhood organizations, community development
organizations, social service organizations, community housing development organizations, community development
organizations, and members of each affected community or neighborhood which might fall into the assistance category of
low and moderate income communities.
MODIFICATIONS
The Recipient must contact IHCDA prior to requesting an amendment or modification that affects the budget, activities,
beneficiaries, or time frame for accomplishing the proposed activities. Substantial amendments may he cause for IHCDA to
review the Application submitted to determine whether the Project is meeting is stated goals and timelines. This Agreement
may not be modified except by an instrument in writing executed by each of the parties hereto. Substantial Amendments to
the budget may have to be submitted to HUD for a final approval.
CONFIDENTIALITY
Recipient must adopt procedures to ensure that all client information is handled and maintained in a confidential manner and
in compliance with the requirements of all applicable state or federal laws, rules, and regulations, including, but not limited
to, those relating to the release of Social Security numbers in I.C. § 4-1-10 and the notice of security breach provisions in
I.C. § 4-1-11.
Confidential information means any individually identifiable information, whether oral or written, about the participants
who receive services and/or assistance from grantees and/or sub -recipients of the IHCDA. Employees, agents, contractors
or others who require access to confidential client information must sign a confidentiality agreement commensurate with the
conditions set forth in this Agreement.
BONDING RE UIREMENTS.
For any construction contracts or subcontracts exceeding $100,000, the following is required:
a. A bid guarantee from each bidder equivalent to five percent (S%) of the bid price. The "bid guarantee" shall
consist of a firm commitment such as a bid bond, certified check, or other negotiable instrument accompanying a
bid as assurance that the bidder will, upon acceptance of his bid, execute such contractual documents as may be
required within the time specified.
b. A performance bond on the part of the contractor for one hundred percent (100%) of the contract price. A
"performance bond" is a bond executed in connection with a contract to secure fulfillment of all the contractor's
obligations under such contract.
c. A payment bond on the part of the contractor for one hundred percent (100%) of the contract price. A "payment
bond" is a bond executed in connection with a contract to assure payment as required by law of all persons
supplying labor and material in the execution of the work provided for in the contract.
d. Where bonds are required:
The bonds shall be obtained from companies holding'certificates of authority as acceptable sureties pursuant to 31 CFR pant
223, "Surety Companies Doing Business with the United States."
LIEN WAIVERS
For any construction contract or subcontract exceeding $100,000, the Recipient must ensure that each contractor executes a
lien waiver for all services, construction work performed, materials furnished, and equipment and fixtures furnished.
IHCDA must receive copies of any and all affidavits, indemnity agreements, lien waivers, certificates, and other documents
as requested.
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Paee 16 of 23
FLOOD PLAIN PROHIBITION
The Award cannot be used to rehabilitate a home where it or its land is located within the boundaries of a one hundred
(100)-year floodplain.
CONSTRUCTION SIGNAGE
If construction signage is used that mentions the names of any specific funding entities, the Indiana Housing and
Community Development Authority's name shall appear on such signage.
CONFLICT OF INTEREST POLICY
The Recipient must maintain written standards of conduct covering conflicts of interest and governing the performance of
its employees engage in the selection, award and administration of contracts. Codes of conduct must prohibit real and
apparent conflicts of interest that may arise among officers, employees, or agents; prohibit the solicitation and acceptance of
gifts or gratuities over minimal value by officers, employees, or agents for their personal benefit; and outline administrative
and disciplinary actions available to remedy violations of such standards. No employee, officer, or agent may participate in
the selection, award, or administration of a contract supported by the Award if he or she has a real or apparent conflict of
interest. Such a conflict of interest would arise when the 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 or a tangible personal benefit from a firm considered for a contract. The officers, employees,
and agents of the Recipient may neither solicit nor accept gratuities, favors, or anything of monetary value from contractors
or parties to subcontracts. However, the Recipient may set standards for situations in which the financial interest is not
substantial or the gift is an unsolicited item of nominal value. The standards of conduct must provide for disciplinary actions
to be applied for violations of such standards by officers, employees, or agents of the Recipient.
If the Recipient has a parent, affiliate, or subsidiary organization that is not a state, Iocal government, or Indian tribe, the
Recipient must also maintain written standards of conduct covering organizational conflicts of interest. Organizational
conflicts of interest means that because of relationships with a parent company, affiliate, or subsidiary organization, the
Recipient is unable or appears to be unable to be impartial in in administering the award or conducting a procurement action
involving a related organization.
The Recipient's procedures must avoid acquisition of unnecessary or duplicative items. Consideration should be given to
consolidating or breaking out procurements to obtain a more economical purchase. Where appropriate, an analysis will be
made of lease versus purchase alternatives, and any other appropriate analysis to determine the most economical approach.
CONFLICT OF INTEREST DISCLOSURE
The Recipient must disclose in writing any potential conflict of interest to IHCDA.
MANDATORY DISCLOSURE
The Recipient must disclose, in a timely manner, in writing to IHCDA all violations of Federal criminal Iaw involving fraud,
bribery, or gratuity violations potentially affecting the Award. The Recipient's failure to make these disclosures may
subject to the Recipient to remedies of non-compliance set forth in 2 CFR 200,338, which includes suspension or
debarment.
INTERNAL CONTROLS
The Recipient must:
A. Establish and maintain effective internal control over federal funds that provides reasonable assurance that
the Recipient is managing federal funds in compliance with Federal statutes, regulations, and the terms
and conditions of the federal funding. These internal controls should be in compliance with guidance in
"Standards for Internal Control in the Federal Government" issued by the Comptroller General of the
United States or the "Internal Control Integrated Framework", issued by the Committee of Sponsoring
Organizations of the Treadway Commission (COSO).
B. Comply with Federal statutes, regulations, and the terms and conditions of federal funds.
C. Evaluate and monitor the Recipient's compliance with statutes, regulations and the terms and conditions
of the federal funds.
LEAD- CITY of SOUTH BEND LD-019-003
Recapture Page 17 of23
D. `fake prompt action when instances of noncompliance are identified including noncompliance identified in
audit findings.
E. Take reasonable measures to safeguard protected personally identifiable information and other
information that IHCDA or HUD designates as sensitive or the Recipient considers sensitive consistent
with applicable Federal, state, local, and tribal laws regarding privacy and obligations of confidentiality.
LEAD- CITY of SOUM BEND LD-018-003
_... _ Paee 18 of23
EXHIBIT B
BUDGET
Agreement Number: DR20R-018-003
Recipient: City of South Bend
Funding Source/Activity Type: LI3RD
Budget Line -Item
Total Allowable Amount
Per Unit Requirements
W
Contract for Hazard Control ork
$281,250
$10,000/unit
Risk Assessment/Inspection
$4f,400
$900/tint
Clearance
$11,400
$285/unit
Staff Su oEt
$107,001
N/A
Personnel (Direct Labor
$22,900
N/A
Healthy Homes Supplemental Funding
$65,000
$5,000/unit
HUD Share total
1 $528,951
LEAD- CITY of SOUTH BEND LD-018-003
T)-,,f.- Page 19 of23
BENCHMARK SCHEDULE
SEE THE ATTACHED BENCHMARK SCHEDULE WITH THIS AWARD.
LEAD- CITY of SOUTH BEND LD-0 f 8-003
Recapture Page 20 of 23
EXHIBIT C
LEAD GRANT ASSURANCES AND CERTIFICATION
The Recipient hereby represents and warrants that:
1) It possesses legal authority to execute the proposed program.
2) Its governing body has duly adopted or passed as an official act a resolution, motion or similar action authorizing
the execution of this Agreement, including all understandings and assurances contained herein, and directing and
authorizing the person identified as the official representative of the Recipient to act in connection with this
Agreement and to provide such additional information as may be required.
3) It will comply with:
A. Title VI of the Civil Rights Act of 1964 (Public Law 88-352, 42 U.S.C. 2000d), which provides that no
person in the United States shall on the grounds of race, color, or national origin, be excluded from
participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program
or activity for which the Recipient received Federal financial assistance. If any real property or structure
thereon is provided or improved with the aid of Federal financial assistance extended to the Recipient, this
assurance shall obligate the Recipient, or in the case of any transfer of such property, any transferee, for
the period during which the real property or structure is used for a purpose for which Federal financial
assistance is extended, or for another purpose involving the provision of similar services or benefits;
B. The Fair Housing Act (Public Law 90-284, 42 U.S.C. 3601-20) administering all programs and activities
relating to housing and community development in a manner to affirmatively further fair housing in the
sale or rental of housing, the financing of housing, and the provision of brokerage services;
C. Section 109 of Title I of the Housing and Community Development Act of 1987, as amended, and the
regulations issued pursuant thereto (24 CFR 570.602), which prohibits any person from discrimination in
the sale or rental of housing, the financing of housing, or the provision of brokerage services on the
grounds of race, color, religion, sex, national origin, handicap or familial status.
D. Any prohibition against discrimination on the basis of age under the Age Discrimination Act of 1975 or
with respect to otherwise qualified physically disabled individuals as provided in Section 504 of the
Rehabilitation Act of 1973 shall also apply to any such program activity;
E. Executive Order 11063, as amended by Executive Order 12259 on equal opportunity in housing and non-
discrimination in the sale or rental of housing built with Federal assistance, and requiring that programs
and activities relating to housing and urban development be administered in a manner affirmatively to
further the goals of Title VIII of the Civil Rights Act of 1968; and
F. Executive Order 11246 as amended by Executive Order 11375 and 12086, and the regulations issued
pursuant thereto (24 CFR Part 130 and 41 Chapter 60 and the Indiana Code (I.C. 22-9-10)), which
provides that no person shall be discriminated against on the basis of race, color, religion, sex or national
origin in all phases of employment during the performance of Federal or federally assisted construction
contracts. Contractors and subcontractors on Federal and federally assisted construction contract shall
take affirmative action to insure fair treatment in employment, upgrading, demotion, or transfer;
recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation
and selection for training and apprenticeship.
4) It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended, requiring that to
the greatest extent feasible opportunities for training and employment be given to lower income residents of the
project area and contracts for work in connection with the project be awarded to eligible business concerns which
are located in, or owned in substantial part by, persons residing within the unit of local government.
LEAD- CITY of SOUTH BEND LD-018-003
Recapture Page 21 of 23
5) It will establish safeguards to prohibit employees from using positions for a purpose that is or gives the appearance
of being motivated by a desire for private gain for themselves or others, particularly those with whom they have
family, business or other ties.
6) It will comply with the provisions of the Hatch Act which limits the political activity of employees.
7) It will give the State, I.HCDA, HUD and the Comptroller General, through any authorized representatives, access to
and the right to examine all records, books, papers, or documents related to the loan.
RecipientRecipient
8) It will comply with:
A. The National Environmental Policy Act of 1969 (42 U.S.C. 4321) and 24 CFR 58, and in connection with
its performance of environmental assessments under the National Environmental Policy Act of 1969,
comply with Section 106 of the National Historic Preservation Act of 1966 (16 U.S.C. 470), Executive
Order 11593, and the Preservation of Archaeological and Historical Data Act of 1966 (U.S.C. 469a-1) by:
1. Consulting with the State Historic Preservation Officer to identify properties listed in or eligible
for inclusion in the National Register of Historic Places that are subject to adverse affects (see 36
CFR 800.8) by the proposed activity; and
2. Complying with all requirements established by the State and to avoid or mitigate adverse effects
upon such properties.
B. Executive Order 11989, Floodplain Management;
C. Executive Order 11990, Protection of Wetlands;
D. The Endangered Species Act of 1973, as amended, (16 U.S.C. 1531);
E. The Fish and Wildlife Coordination Act of 1958, as amended, (16 U.S.C. 661);
F. The Wild and Scenic Rivers Act of 1968, as amended, (16 U.S.C. 300f);
G. The Safe Drinking Water Act of 1974, as amended, (42 U.S.C. 7401);
H. Section 401(f) of the Lead -Based Paint Poisoning Prevention Act, as amended, (42 U.S.C. 4831(b));
I. The Clean Air Act of 1970, as amended, (42 U.S.C. 7401);
J. The Federal Water Pollution Control Act of 1972, as amended, (33 U.S.C. 1251);
K. The Clean Water Act of 1977 (Public Law 95-217);
L. The Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act of 1976 (42
U.S.C. 6901); and
M. Section 202(a) of the Flood Disaster Protection Act of 1973 (42 U.S.C. 4106) as it relates to the
mandatory purchase of flood insurance for special flood hazard areas.
9) It agrees to repay to the State of Indiana any funds under this program that, as the result of a HUD or State of
Indiana authorized audit, are found to have been spent in an unauthorized manner or for unauthorized activities.
10) It certifies that none of the funds being applied for will be used to substitute for any local, state, federal or private
dollars that have been committed to the project as proposed in this application,
11) It certifies that pursuant to 31 U.S.C. 1352, and any regulations promulgated thereunder:
A. No federal appropriated fiords have been paid or will be paid, by or on behalf of the Recipient, to any
person for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of 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 Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with the
LEAD- CITY of SOUTH BEND LD-018-003
Recapture Page 22 of23
proposed Federal contract, grant, loan or cooperative agreement, the Recipient shall complete and submit
Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
C. The Recipient shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
12) Recipient hereby authorizes THCDA and its successors, affiliates, agents and assigns to utilize in any manner and at
any time, any photograph, picture or other medium (collectively "photographs") of the property covered by this
Application, without limitation, in any and all matters, publications or endeavors, commercial or noncommercial,
undertaken directly or indirectly by THCDA at any time on or after the date of this Recipient without any limitation
whatsoever. Recipient understands that: (i) it is relinquishing any and all ownership rights in any such photograph,
picture or medium to THCDA; and, (ii) it is relinquishing any and all legal rights that it may now or hereafter have
to, directly or indirectly, challenge, question or otherwise terminate the use of the photograph by THCDA.
13) Neither the Recipient nor its principals or its subcontractors is presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded by any Federal department or agency from doing business
with the Federal Government,
LEAD- CITY of SOUTII BEND LD-018-003
De,,,,„,, — Page 23 of 23
Indiana Housing and Community Development Authority
Authorized Contact Information Foam
Please indicate below the name(s) of the authorized contact person(s) for this award. This is the
individual that 1HCDA will contact should we have any questions regarding this award.
Applicant: City of South Bend
Award Number: LD-018-003
Applicant Contact Name:
Organization:
Title:
Email Address:
Sub recipient Contact Name:
Organization:
Title:
Email Address:
Administrator Contact Name:
Organization:
Title:
Email Address:
Signed:
Authorized Signatory of Applicant
Title
Date of Signature
Phone Number:
Phone Number:
Phone Number:
Recipient Approval
Indiana Housing and Community Developtneift Authofity
111CMApproval
("IHCDA")
Reripiarrt
Authorized Signature Form
Hereby autliodzes any of [lie following
Director of Rost Estate Production
individuals whose authenticated signatures
this form to sign contracts,
st ust be
n-k roust 'nnis forbe approved by the primary authorized signatory and eivabgummu
appear on
agreements, aniendinarns, niodifications, and
acknowledged by a Notary Public
ACH Authorization Forms for awards on behalf
of Recipient. Accordingly, any contracts,
rigreenrents, amendments, modifications, and
CrfY OF SOUTH REND
ACH Authorization Forms executed by any of
the individuals listed below shall he binding
LD-018-003
upon the, Recipient.
By: Primary Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
APTUOVED
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7)q)od Title
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Date
Date,
Date
Notary Public
Notary Public
Notary Public
Subscribed and swom before me this day of
Subscribed and sworn before rue Ild s day of
Subscribed and swom before me this_ day of
Subscribed and 5worn before me this day or
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Counly of Residence
County OfResidence
County of Residence
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Seal:
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'rhis, document supersedes A other authorizations and shall continue in force until expiration ofaward(s) or a new authorization bas been received.
"hcda000
Dltji�uo Hollsillq ,A isk);1olumil Dpve opulef�l Alyilwi4)
Grantee ACH Authorization Form
A voided check may be attached to this form.
Organization
Funds Information
(Grant Agreement Number with IHCDA) (CFDA Number)
(Name of Financial Institution)
(Address of Financial Institution)
Account Type: ❑Checking ]Savings
Financial Institution Routing Number:
Account Number:
These numbers are located on the bottom of your check as follows:
p,wli3rlkstHdMr�Ar-ti!MttNN�vtd.Ni
(Signature)
(Date)
ADDRESS 30 South Meridian Street, Suite 1000, Indianapolis, IN 46204
® PHONE 317 232 7777 TOLL FREE 800 872 0371 WEB www.ihcda.[N.gov Statn ailndiana �
Lieuten:meGovernor �- F1
s�xr�sr Suzanne Crouch
EQUAL OPPORTUNITY EMPLOYER AND HOUSING AGENCY
Federal Labor Standards Provisions U.S. Department of Housing
and Urban Development
Office of Labor Relations
Applicability
The Project or Program to which the construction work
covered by this contract pertains is being assisted by the
United States of America and the following Federal Labor
Standards Provisions are included in this Contract
pursuant to the provisions applicable to such Federal
assistance.
A. 1. (1) Minimum Wages. All laborers and mechanics
employed or working upon the site of the work, will be paid
unconditionally and not less often than once a week, and
without subsequent deduction or rebate on any account
(except such payroll deductions as are permitted by
regulations issued by the Secretary of Labor under the
Copeland Act (29 CFR Part 3), the full amount of wages
and bona fide fringe benefits (or cash equivalents thereof)
due at time of payment computed at rates not less than
those contained in the wage determination of the
Secretary of Labor which is attached hereto and made a
part hereof, regardless of any contractual relationship
which may be alleged to exist between the contractor and
such laborers and mechanics. Contributions made or
costs reasonably anticipated for bona fide fringe benefits
under Section.l(b)(2) of the Davis -Bacon Act on behalf of
laborers or mechanics are considered wages paid to such
laborers or mechanics, subject to the provisions of 29 CFR
5.5(a)(1)(iv); also, regular contributions made or costs
incurred for more than a weekly period (but not less often
than quarterly) under plans, funds, or programs, which
cover the particular weekly period, are deemed to be
constructively made or incurred during such weekly period.
Such laborers and mechanics shall be paid the appropriate
wage rate and fringe benefits on the wage determination
for the classification of work actually performed, without
regard to skill, except as provided in 29 CFR 5.5(a)(4).
Laborers or mechanics performing work in more than one
classification may be compensated at the rate specified for
each classification for the time actually worked therein:
Provided, That the employer's payroll records accurately
set forth the time spent in each classification in which
work is performed. The wage determination (including any
additional classification and wage rates conformed under
29 CFR 5.5(a)(1)(ii) and the Davis -Bacon poster (WH-
1321) shall be posted at all times by the contractor and its
subcontractors at the site of the work in a prominent and
accessible, place where it can be easily seen by the
workers.
(it) (a) Any class of laborers or mechanics which is not
listed in the wage determination and which is to be
employed under the contract shall be classified in
conformance with the wage determination. HUD shall
approve an additional classification and wage rate and
fringe benefits therefor only when the following criteria
have been met:
(1) The work to be performed by the classification
requested is not performed by a classification in the wage
determination; and
(2) The classification is utilized in the area by the
construction industry; and
(3) The proposed wage rate, including any bona fide
fringe benefits, bears a reasonable relationship to the
wage rates contained in the wage determination.
(b) If the contractor and the laborers and mechanics to be
employed in the classification (if known), or their
representatives, and HUD or its designee agree on the
classification and wage rate (including the amount
designated for fringe benefits where appropriate), a report
of the action taken shall be sent by HUD or its designee to
the Administrator of the Wage and Hour Division,
Employment Standards Administration, U.S. Department of
Labor, Washington, D.C. 20210. The Administrator, or an
authorized representative, will approve, modify, or
disapprove every additional classification action within 30
days of receipt and so advise HUD or its designee or will
notify HUD or its designee within the 30-day period that
additional time is necessary. (Approved by the Office of
Management and Budget under OMB control number 1215-
0140.)
(c) In the event the contractor, the laborers or mechanics
to be employed in the classification or their
representatives, and HUD or its designee do not agree on
the proposed classification and wage rate (including the
amount designated for fringe benefits, where appropriate),
HUD or its designee shall refer the questions, including
the views of all interested parties and the recommendation
of HUD or its designee, to the Administrator for
determination. The Administrator, or an authorized
representative, will issue a determination within 30 days of
receipt and so advise HUD or its designee or will notify
HUD or its designee within the 30-day period that
additional time is necessary. (Approved by the Office of
Management and Budget under OMB Control Number
1215-0140.)
(d) The wage rate (including fringe benefits where
appropriate) determined pursuant to subparagraphs
(1)(Ei)(b) or (c) of this paragraph, shall be paid to all
workers performing work in the classification under this
contract from the first day on which work is performed in
the classification.
(Ell) Whenever the minimum wage rate prescribed in the
contract for a class of laborers or mechanics includes a
fringe benefit which is not expressed as an hourly rate, the
contractor shall either pay the benefit as stated in the
wage determination or shall pay another bona fide fringe
benefit or an hourly cash equivalent thereof.
(iv) If the contractor does not make payments to a trustee
or other third person, the contractor may consider as part
form HUD-4010 (06/2009)
Previous editions are obsolete Page 1 of 6 ref. Handbook 1344.1
of the wages of any laborer or mechanic the amount of any
costs reasonably anticipated in providing bona fide fringe
benefits under a plan or program, Provided, That the
Secretary of Labor has found, upon the written request of
the contractor, that the applicable standards of the Davis -
Bacon Act have been met. The Secretary of Labor may
require the contractor to set aside in a separate account
assets for the meeting of obligations under the plan or
program. (Approved by the Office of Management and
Budget under OMB Control Number 1215-0140.)
2. Withholding. HUD or its designee shall upon its own
action or upon written request of an authorized
representative of the Department of Labor withhold or
cause to be withhold from the contractor under this
contract or any other Federal contract with the same prime
contractor, or any other Federally -assisted contract
subject to Davis -Bacon prevailing wage requirements,
which is held by the same prime contractor so much of the
accrued payments or advances as may be considered
necessary to pay laborers and mechanics, including
apprentices, trainees and helpers, employed by the
contractor or any subcontractor the full amount of wages
required by the contract In the event of failure to pay any
laborer or mechanic, including any apprentice, trainee or
helper, employed or working on the site of the work, all or
part of the wages required by the contract, HUD or its
designee may, after written notice to the contractor,
sponsor, applicant, or owner, take such action as may be
necessary to cause the suspension of any further
payment, advance, or guarantee of funds until such
violations have ceased. HUD or its designee may, after
written notice to the contractor, disburse such amounts
withheld for and on account of the contractor or
subcontractor to the respective employees to whom they
are due. The Comptroller General shall make such
disbursements in the case of direct Davis -Bacon Act
contracts.
3. (1) Payrolls and basic records. Payrolls and basic
records relating thereto shall be maintained by the
contractor during the course of the work preserved for a
period of three years thereafter for all laborers and
mechanics working at the site of the work. Such records
shall contain the name, address, and social security
number of each such worker, his or her correct
classification, hourly rates of wages paid (including rates
of contributions or costs anticipated for bona fide fringe
benefits or cash equivalents thereof of the types described
I b 2 B f the Davis -bacon Act) dail and
communicated in writing to the laborers or mechanics
affected, and records which show the costs anticipated or
the actual cost incurred in providing such benefits.
Contractors employing apprentices or trainees under
approved programs shall maintain written evidence of the
registration of apprenticeship programs and certification of
trainee programs, the registration of the apprentices and
trainees, and the ratios and wage rates prescribed in the
applicable programs. (Approved by the Office of
Management and Budget under OMB Control Numbers
1215-0140 and 1215-0017.)
(it) (a) The contractor shall submit weekly for each week
in which any contract work is performed a copy of all
payrolls to HUD or its designee if the agency is a party to
the contract, but if the agency is not such a party, the
contractor will submit the payrolls to the applicant
sponsor, or owner, as the case may be, for transmission to
HUD or its designee. The payrolls submitted shall set out
accurately and completely all of the information required
to be maintained under 29 CFR 5,5(a)(3)(i) except that full
social security numbers and home addresses shall not be
included on weekly transmittals. Instead the payrolls shall
only need to include an individually identifying number for
each employee (e.g., the last four digits of the employee's
social security number). The required weekly payroll
information may be submitted in any form desired.
Optional Form WH-347 is available for this purpose from
the Wage and Hour Division Web site at
htt,p://www,dol.govlesalwhd/formslwh347instr.htm or its
successor site. The prime contractor is responsible for
the submission of copies of payrolls by all subcontractors.
Contractors and subcontractors shall maintain the full
social security number and current address of each
covered worker, and shall provide them upon request to
HUD or its designee if the agency is a party to the
contract, but if the agency is not such a party, the
contractor will submit the payrolls to the applicant
sponsor, or owner, as the case may be, for transmission to
HUD or its designee, the contractor, or the Wage and Hour
Division of the Department of Labor for purposes of an
investigation or audit of compliance with prevailing wage
requirements. it is not a violation of this subparagraph for
a prime contractor to require a subcontractor to provide
addresses and social security numbers to the prime
contractor for its own records, without weekly submission
to HUD or its designee. (Approved by the Office of
Management and Budget under OMB Control Number
in Section ( )( ){ ) o y 1215-0149.)
weekly number of hours worked, deductions made and (b) Each payroll submitted shall be accompanied by a
actual wages paid. Whenever the Secretary of Labor has "Statement of Compliance," signed by the contractor or
found under 29 CFR 5.5 (a)(1)(iv) that the wages of any subcontractor or his or her agent who pays or supervises
laborer or mechanic include the amount of any costs the payment of the persons employed under the contract
reasonably anticipated in providing benefits under a plan and shall certify the following:
or program described in Section I(b)(2)(t3) of the Davis- (1) That the payroll for the payroll period contains the
Bacon Act, the contractor shall maintain records which information required to be provided under 29 CFR 5.5
show that the commitment to provide such benefits is (a)(3)(ii), the appropriate information is being maintained
enforceable, that the plan or program is financially under 29 CFR 5.5(a)(3)(1), and that such information is
responsible, and that the plan or program has been correct and complete;
Previous editions are obsolete form HUD-4010 (0612009)
Page 2 of 5 ref. Handbook 1344,1
(2) That each laborer or mechanic (including each helper,
apprentice, and trainee) employed on the contract during
the payroll period has been paid the full weekly wages
earned, without rebate, either directly or indirectly, and
that no deductions have been made either directly or
indirectly from the full wages earned, other than
permissible deductions as set forth in 29 CFR Part 3;
(3) That each laborer or mechanic has been paid not less
than the applicable wage rates and fringe benefits or cash
equivalents for the classification of work performed, as
specified in the applicable wage determination
incorporated into the contract.
(c) The weekly submission of a property executed
certification set forth on the reverse side of Optional Form
WH-347 shall satisfy the requirement for submission of the
"Statement of Compliance" required by subparagraph
A.3.(iI)(b).
(d) The falsification of any of the above certifications may
subject the contractor or subcontractor to civil or criminal
prosecution under Section 1001 of Title 18 and Section
231 of Title 31 of the United States Code.
(tit) The contractor or subcontractor shall make the
records required under subparagraph A,3.(i) available for
inspection, copying, or transcription by authorized
representatives of HUD or Its designee or the Department
of Labor, and shall permit such representatives to
interview employees during working hours on the job. if
the contractor or subcontractor fails to submit the required
records or to make them available, HUD or its designee
may, after written notice to the contractor, sponsor,
applicant or owner, take such action as may be necessary
to cause the suspension of any further payment, advance,
or guarantee of funds. Furthermore, failure to submit the
required records upon request or to make such records
available may be grounds for debarment action pursuant to
29 CFR 5.12.
Apprentices and Trainees.
(i) Apprentices. Apprentices will be permitted to work at
less than the predetermined rate for the work they
performed when they are employed pursuant to and
individually registered in a bona fide apprenticeship
program registered with the U.S. Department of Labor,
Employment and Training Administration, Office of
Apprenticeship Training, Employer and Labor Services, or
with a State Apprenticeship Agency recognized by the
Office, or if a person is employed in his or her first 90
days of probationary employment as an apprentice in such
an apprenticeship program, who is not individually
registered in the program, but who has been certified by
the Office of Apprenticeship Training, Employer and Labor
Services or a State Apprenticeship Agency (where
appropriate) to be eligible for probationary employment as
an apprentice. The allowable ratio of apprentices to
journeymen on the job site in any craft classification shall
not be greater than the ratio permitted to the contractor as
to the entire work force under the registered program. Any
t' t who
is not registered or otherwise employed as stated above,
shall be paid not less than the applicable wage rate on the
wage determination for the classification of work actually
performed. In addition, any apprentice performing work on
the job site in excess of the ratio permitted under the
registered program shall be paid not less than the
applicable wage rate on the wage determination for the
work actually performed. Where a contractor is performing
construction on a project in a locality other than that in
which its program is registered, the ratios and wage rates
(expressed in percentages of the journeyman's hourly
rate) specified in the contractor's or subcontractor's
registered program shall be observed. Every apprentice
must be paid at not less than the rate specified in the
registered program for the apprentice's level of progress,
expressed as a percentage of the journeymen hourly rate
specified in the applicable wage determination.
Apprentices shall be paid fringe benefits in accordance
with the provisions of the apprenticeship program. If the
apprenticeship program does not specify fringe benefits,
apprentices must be paid the full amount of fringe benefits
listed on the wage determination for the applicable
classification. If the Administrator determines that a
different practice prevails for the applicable apprentice
classification, fringes shall be paid in accordance with that
determination. In the event the Office of Apprenticeship
Training, Employer and Labor Services, or a State
Apprenticeship Agency recognized by the Office,
withdraws approval of an apprenticeship program, the
contractor will no longer be permitted to utilize
apprentices at less than the applicable predetermined rate
for the work performed until an acceptable program is
approved.
(11) Trainees. Except as provided in 29 CFR 5.16,
trainees will not be permitted to work at less than the
predetermined rate for the work performed unless they are
employed pursuant ',to and individually registered in a
program which has received prior approval, evidenced by
formal certification by the U.S. Department of Labor,
Employment and Training Administration. The ratio of
trainees to journeymen on the job site shall not be greater
than permitted under the plan approved by the
Employment and Training Administration. Every trainee
must be paid at not less than the rate specified in the
approved program for the trainee's level of progress,
expressed as a percentage of the journeyman hourly rate
specified in the applicable wage determination. Trainees
shall be paid fringe benefits in accordance with the
provisions of the trainee program. If the trainee program
does not mention fringe benefits, trainees shall be paid
the full amount of fringe benefits listed on the wage
determination unless the Administrator of the Wage and
Hour Division determines that there is an apprenticeship
program associated with the corresponding journeyman
wage rate on the wage determination which provides for
less than full fringe benefits for apprentices. Any
employee listed on the payroll at a trainee rate who is not
registered and participating in a training plan approved by
worker listed on a payroll at an appren ice wage ra e,
Previous editions are obsolete form HUD-4010 (06/2009)
Page 3 of 5 ref. Handbook 1344.1
the Employment and Training Administration shall be paid
not less than the applicable wage rate on the wage
determination for the work actually performed. In addition,
any trainee performing work on the job site in excess of
the ratio permitted under the registered program shall be
paid not less than the applicable wage rate on the wage
determination for the work actually performed. In the
event the Employment and Training Administration
withdraws approval of a training program, the contractor
will no longer he permitted to utilize trainees at less than
the applicable predetermined rate for the work performed
until an acceptable program is approved.
(iii) Equal employment opportunity. The utilization of
apprentices, trainees and journeymen under 29 CFR Part 5
shall be in conformity with the equal employment
opportunity requirements of Executive Order 11246, as
amended, and 29 CFR Part 30.
5. Compliance with Copeland Act requirements. The
contractor shall comply with the requirements of 29 CFR
Part 3 which are incorporated by reference in this contract
6. Subcontracts. The contractor or subcontractor will
insert in any subcontracts the clauses contained in
subparagraphs 1 through 11 in this paragraph A and such
other clauses as HUD or its designee may by appropriate
instructions require, and a copy of the applicable
prevailing wage decision, and also a clause requiring the
subcontractors to include these clauses in any lower tier
subcontracts. The prime contractor shall be responsible
for the compliance by any subcontractor or lower tier
subcontractor with all the contract clauses in this
paragraph,
7. Contract termination; debarment. A breach of the
contract clauses in 29 CFR 5.5 may be grounds for
termination of the contract and for debarment as a
contractor and a subcontractor as provided in 29 CFR
5.12,
8. Compliance with Davis -Bacon and Related Act Requirements.
All rulings and interpretations of the Davis -Bacon and
Related Acts contained in 29 CFR Parts 1, 3, and 5 are
herein incorporated by reference in this contract
9. Disputes concerning labor standards. Disputes
arising out of the labor standards provisions of this
contract shall not be subject to the general disputes
clause of this contract. Such disputes shall be resolved in
accordance with the procedures of the Department of
Labor set forth in 29 CFR Parts 5, 6, and 7. Disputes
within the moaning of this clause include disputes between
the contractor (or any of its subcontractors) and HUD or
its designee, the U.S. Department of Labor, or the
employees or their representatives.
10. (1) Certification of Eligibility. By entering into this
contract the contractor certifies that neither it (nor he or
she) nor any person or firm who has an interest in the
contractor's firm is a person or firm ineligible to be
awarded Government contracts by virtue of Section 3(a) of
the Davis -Bacon Act or 29 CFR 5.12(a)(1) or to be
awarded HUD contracts or participate in HUD programs
pursuant to 24 CFR Part 24.
(11) No part of this contract shall be subcontracted to any
person or firm ineligible for award of a Government
contract by virtue of Section 3(a) of the Davis -Bacon Act
or 29 CFR 5.12(a)(1) or to be awarded HUD contracts or
participate in HUD programs pursuant to 24 CFR Part 24.
(if!) The penalty for making false statements is prescribed
in the U.S. Criminal Code, 18 U.S.C. 1001, Additionally,
U.S. Criminal Code, Section 1 01 0, Title 18, U.S.C.,
"Federal Housing Administration transactions", provides in
part: "Whoever, for the purpose of . . . influencing in any.
way the action of such Administration ..... makes, utters or
publishes any statement knowing the same to be false.....
shall be fined not more than $5,000 or imprisoned not
more than two years, or both."
11. Complaints, Proceedings, or Testimony by
Employees. No laborer or mechanic to whom the wage,
salary, or other labor standards provisions of this Contract
are applicable shall be discharged or in any other manner
discriminated against by the Contractor or any
subcontractor because such employee has filed any
complaint or instituted or caused to be instituted any
proceeding or has testified or is about to testify in any
proceeding under or relating to the labor standards
applicable under this Contract to his employer.
B. Contract Work Hours and Safety Standards Act. The
provisions of this paragraph B are applicable where the amount of the
prime contract exceeds $100,000. As used in this paragraph, the
terms "laborers" and "mechanics" include watchmen and guards.
(1) Overtime requirements. No contractor or subcontractor
contracting for any part of the contract work which may require or
involve the employment of laborers or mechanics shall require or
permit any such laborer or mechanic in any workweek in which the
individual is employed on such work to work in excess of 40 hours in
such workweek unless such laborer or mechanic receives
compensation at a rate not less than one and one-half times the basic
rate of pay for all hours worked in excess of 40 hours In such
workweek.
(2) Violation; liability for unpaid wages; liquidated
damages. In the event of any violation of the clause set
forth in subparagraph (1) of this paragraph, the contractor
and any subcontractor responsible therefor shall be liable
for the unpaid wages. In addition, such contractor and
subcontractor shall be liable to the United States (in the
case of work done under contract for the District of
Columbia or a territory, to such District or to such
territory), for liquidated damages. Such liquidated
damages shall be computed with respect to each individual
laborer or mechanic, including watchmen and guards,
employed in violation of the clause set forth in
subparagraph (1) of this paragraph, in the sum of $10 for each
calendar day on which such individual was required or permitted to
work in excess of the standard workweek of 40 hours without payment
of the overtime wages required by the clause set forth in sub
paragraph (1) of this paragraph.
Previous editions are obsolete form HUD-4010 (06/2009)
Page 4 of 5 ref. Handbook 1344.1
(3) Withholding for unpaid wages and liquidated
damages. HUD or its designee shall upon its own action
or upon written request of an authorized representative of
the Department of Labor withhold or cause to be withheld,
from any moneys payable on account of work performed by
the contractor or subcontractor under any such contract or
any other Federal contract with the same prime contract,
or any other Federally -assisted contract subject to the
Contract Work Hours and Safety Standards Act which is
hold by the same prime contractor such sums as may be
determined to be necessary to satisfy any liabilities of
such contractor or subcontractor for unpaid wages and
liquidated damages as provided in the clause set forth in
subparagraph (2) of this paragraph.
(4) Subcontracts. The contractor or subcontractor shall
insert in any subcontracts the clauses set forth in
subparagraph (1) through (4) of this paragraph and also a
clause requiring the subcontractors to include these
clauses in any lower tier subcontracts. The prime
contractor shall be responsible for compliance by any
subcontractor or lower tier subcontractor with the clauses
set forth in subparagraphs (1) through (4) of this
paragraph.
C. Health and Safety. The provisions of this paragraph C are
applicable where the amount of the prime contract exceeds $100,000.
(1) No laborer or mechanic shall be required to work in
surroundings or under working conditions which are
unsanitary, hazardous, or dangerous to his health and
safety as determined under construction safety and health
standards promulgated by the Secretary of Labor by
regulation.
(2) The Contractor shall comply with all regulations
issued by the Secretary of Labor pursuant to Title 29 Part
1926 and failure to comply may result in imposition of
sanctions pursuant to the Contract Work Hours and Safety
Standards Act, (Public Law 91-54, 83 Stat 96). 40 USC
3701 of seq.
(3) The contractor shall include the provisions of this
paragraph in every subcontract so that such provisions will
be binding on each subcontractor. The contractor shall
take such action with respect to any subcontractor as the
Secretary of Housing and Urban Development or the
Secretary of Labor shall direct as a means of enforcing
such provisions.
Previous editions are obsolete form HUD-4010 (06/2009)
Page 5 of 5 ref. Handbook 1344.1
ApplicantlRecipient U.s, Department of Housing OMB Approval No. 2510-0011 (exp. 10/31/2009)
Disclosure/Update Report and Urban Development
Instructions. (See Public Reporting Statement and Privacy Act Statement and detailed instructions on page 2.)
A licant/Reci lent Information Indicate whether this Is an Initial Report ❑ or an Update Report ❑
, Address, and Phone (include area code):
3. HUD Program Name
5. State the name and location (street address, City and State) of the project or activity:
2. Social Security Number or
Employer 1D Number:
4. Amount of HUD Assistance
Requested/Received
Part I Threshold Determinations
1. Are you applying for assistance for a specific project or activity? These 2. Have you received or do you expect to receive assistance within the
terms do not include formula grants, such as public housing operating jurisdiction of the Department (HUD) , involving the project or activity in
subsidy or CDBG block grants. (For further information see 24 CFR Sec. this application, In excess of $200,000 during this fiscal year (Oct. 1 -
4.3). Sep. 30)? For further information, see 24 CFR Sec. 4.9
❑ Yes ❑ No ❑ Yes ❑ No.
If you answered "No" to either question 1 or 2, Stop! You do not need to complete the remainder of this form.
However, you must sign the certification at the end of the report.
Part II Other Government Assistance Provided or Requested 1 Expected Sources and Use of Funds.
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit, or tax benefit.
Department/State/Local Agency Name and Address Type of Assistance Amount Expected Uses of the Funds
Use Additional
Part III Interested Parties, You must disclose:
1. All developers, contractors, or consultants involved in the application for the assistance or in the planning, development, or implementation of the
project or activity and
2. any other person who has a financial interest in the project or activity for which the assistance is sought that exceeds $50,000 or 10 percent of the
assistance (whichever is lower).
Alphabetical list of all persons with a reportable financial interest
in the project or activity For individuals, give the last name first
Social Security No.
or Employee ID No.
Type of Participation in
Project/Activity
Financial Interest in
Pro ect/Activif $ and
(Note: Use Additional pages if necessary.)
Certification
Warning: if you knowingly make a false statement on this form, you may be subject to civil or criminal penalties under Section 1001 of Title 18 of the
United States Code. In addition, any person who knowingly and materially violates any required disclosures of information, including intentional non-
disclosure, is subject to civil money penalty not to exceed $10,000 for each violation.
I certify that this information is true and complete.
Date: (mmldd/yyyy)
X
Form HUD-2880 (3199)
Public reporting burden for this collection of information is estimated to average 2.0 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency
may not conduct or sponsor, and a person is not required to respond to, a collection information unless that collection displays a valid OMB control
number.
Privacy Act Statement. Except for Social Security Numbers (SSNs) and Employer Identification Numbers (EINs), the Department of Housing and Urban
Development (HUD) is authorized to collect all the information required by this form under section 102 of the Department of Housing and Urban
Development Reform Act of 1989, 42 U.S.C. 3531. Disclosure of SSNs and Elks is optional, The SSN or EIN is used as a unique identifier. The
information you provide will enable HUD to carry out its responsibilities under Sections 102(b), (c), and (d) of the Department of Housing and Urban
Development Reform Act of 1989, Pub. L. 101-235, approved December 15, 1989. These provisions will help ensure greater accountability and integrity
in the provision of certain types of assistance administered by HUD. They will also help ensure that HUD assistance for a specific housing project under
Section 102(d) is not more than is necessary to make the project feasible after taking account of other government assistance. HUD will make available to
the public all applicant disclosure reports for five years in the case of applications for competitive assistance, and for generally three years in the case of
other applications. Update reports will be made available along with the disclosure reports, but to no case for a period generally less than three years. All
reports, both initial reports and update reports, will be made available in accordance with the Freedom of Information Act (5 U.S.C. §552) and HUD's
implementing regulations at 24 CFR Part 15. HUD will use the information in evaluating individual assistance applications and in performing infernal
administrative analyses to assist in the management of specific HUD programs. The information will also be used in making the determination under
Section 102(d) whether HUD assistance for a specific housing project is more than is necessary to make the project feasible after taking account of other
government assistance. You must provide all the required information. Failure to provide any required information may delay the processing of your
application, and may result in sanctions and penalties, including imposition of the administrative and civil money penalties specified under 24 CFR §4.38.
Note: This form only covers assistance made available by the Department. States and units of general local government that carry out responsibilities
under Sections 102(b) and (c) of the Reform Act must develop their own procedures for complying with the Act.
Instructions
Overview.
A. Coverage. You must complete this report if:
(1) You are applying for assistance from HUD for a specific project or
activity and you have received, or expect to receive, assistance
from HUD in excess of $200,000 during the during the fiscal year;
(2) You are updating a prior report as discussed below; or
(3) You are submitting an application for assistance to an entity other
than HUD, a State or local government if the application is required
by statute or regulation to be submitted to HUD for approval or for
any other purpose.
S. Update reports (filed by "Recipients" of HUD Assistance):
General. All recipients of covered assistance must submit update
reports to the Department to reflect substantial changes to the initial
applicant disclosure reports.
Line -by -Line Instructions.
Applicant/Recipient Information.
All applicants for HUD competitive assistance, must complete the
information required in blocks 1-5 of form HUD-2880:
1, Enter the full name, address, city, State, zip code, and telephone
number (including area code) of the applicant/recipient. Where the
applicantlrecipient is an individual, the last name, first name, and
middle initial must be entered.
2. Entry of the applicantfreciplent`s SSN or EIN, as appropriate, is
optional.
3. Applicants enter the HUD program name under which the assistance is
being requested.
4. Applicants enter the amount of HUD assistance that is being
requested. Recipients enter the amount of HUD assistance that has
been provided and to which the update report relates. The amounts
are those stated in the application or award documentation. NOTE: In
the case of assistance that Is provided pursuant to contract over a
period of time (such as project -based assistance under section 8 of the
United States Housing Act of 1937), the amount of assistance to be
reported includes all amounts that are to be provided over the term of
the contract, irrespective of when they are to be received.
5. Applicants enter the name and full address of the project or activity for
which the HUD assistance is sought. Recipients enter the name and
full address of the HUD -assisted project or activity to which the update
report relates. The most appropriate government identifying number
must be used (e.g., RFP No.; IFB No.; grant announcement No.; or
contract, grant, or loan No.) Include prefixes.
Part I. Threshold Determinations -Applicants Only
Part I contains information to help the applicant determine whether the
remainder of the form must be completed. Recipients filing Update
Reports should not complete this fart.
If the answer to either questions 1 or 2 is No, the applicant need not
complete Parts 11 and Ill of the report, but must sign the certification at the
end of the form.
Part It. Other Government Assistance and Expected Sources and
Uses of Funds.
A. Other Government Assistance. This Part is to be completed by both
applicants and recipients for assistance and recipients filing update
reports. Applicants and recipients must report any other government
assistance involved in the project or activity for which assistance is
sought. Applicants and recipients must report any other government
assistance involved in the project or activity. Other government
assistance is defined in note 4 on the last page. For purposes of this
definition, other government assistance is expected to be made
available if, based on an assessment of all the circumstances involved,
there are reasonable grounds to anticipate that the assistance will be
forthcoming.
Both applicant and recipient disclosures must include all other
government assistance involved with the HUD assistance, as well as
any other government assistance that was made available before the
request, but that has continuing vitality at the time of the request.
Examples of this latter category include tax credits that provide for a
number of years of tax benefits, and grant assistance that continues to
benefit the project at the time of the assistance request.
The following information must be provided:
1. Enter the name and address, city, State, and zip code of the
government agency making the assistance available.
2. State the type of other government assistance (e.g., loan, grant,
loan insurance).
3, Enter the dollar amount of the other government assistance that is,
or is expected to be, made available with respect to the project or
activities for which the HUD assistance is sought (applicants) or
has been provided (recipients).
4. Uses of funds. Each reportable use of funds must clearly identify
the purpose to which they are to be put Reasonable aggregations
may be used, such as "total structure" to include a number of
structural costs, such as roof, elevators, exterior masonry, etc.
B. Non -Government Assistance. Note that the applicant and recipient
disclosure report must specify all expected sources and uses of funds -
both from HUD and any other source -that have been or are to be,
made available for the project or activity. Non -government sources of
Form HUD-2880 (3199)
funds typically include (but are not limited to) foundations and private
contributors.
Part III. Interested Parties.
This Part is to be completed by both applicants and recipients filing update
reports. Applicants must provide information on:
1. All developers, contractors, or consultants involved in the application
for the assistance or in the planning, development, or implementation
of the project or activity and
2. any other person who has a financial interest in the project or activity
for which the assistance is sought that exceeds $50,000 or 10 percent
of the assistance (whichever is lower).
Note: A financial interest means any financial involvement in the
project or activity, including (but not limited to) situations in which an
individual or entity has an equity interest in the project or activity,
shares in any profit on resale or any distribution of surplus cash or
other assets of the project or activity, or receives compensation for any
goods or services provided in connection with the project or activity.
Residency of an individual in housing for which assistance is being
sought is not, by itself, considered a covered financial interest.
The information required below must be provided.
1. Enter the full names and addresses. If the person is an entity, the
listing must include the full name and address of the entity as well as
the CEO. Please fist all names alphabetically.
2. Entry of the Social Security Number (SSN) or Employee Identification
Number (EIN), as appropriate, for each person listed is optional.
3. Enter the type of participation in the project or activity for each person
listed: i.e„ the person's specific role in the project (e.g., contractor,
consultant, planner, investor).
4. Enter the financial interest in the project or activity for each person
listed. The interest must be expressed both as a dollar amount and as
a percentage of the amount of the HUD assistance involved.
Note that if any of the sourceluse information required by this report has
been provided elsewhere in this application package, the applicant need
not repeat the information, but need only refer to the form and location to
incorporate it into this report. (it is likely that some of the information
required by this report has been provided on SF 424A, and on various
budget forms accompanying the application.) If this report requires
information beyond that provided elsewhere in the application package,
the applicant must include in this report all the additional information
required.
Recipients must submit an update report for any change in previously
disclosed sources and uses of funds as provided in Section I.D.S., above.
Notes:
1. All citations are to 24 CFR Part 4, which was published in the Federal
Register. [April 1, 1996, at 63 Fed. Reg. 14448.]
2. Assistance means any contract, grant, loan, cooperative agreement, or
other form of assistance, including the insurance or guarantee of a loan
or mortgage, that is provided with respect to a specific project or
activity under a program administered by the Department. The term
does not include contracts, such as procurements contracts, that are
subject to the Fed, Acquisition Regulation (FAR) (48 CFR Chapter 1).
3, See 24 CFR §4.9 for detailed guidance on how the threshold is
calculated,
4. "Other government assistance" is defined to include any loan, grant,
guarantee, insurance, payment, rebate, subsidy, credit, tax benefit, or
any other form of direct or indirect assistance from the Federal
government (other than that requested from HUD in the application), a
State, or a unit of general local government, or any agency or
instrumentality thereof, that is, or is expected to be made, available
with respect to the project or activities for which the assistance is
sought.
5. For the purpose of this form and 24 CFR Part 4, "person" means an
individual (including a consultant, lobbyist, or lawyer); corporation;
company; association; authority; firm; partnership; society; State, unit
of general focal government, or other government entity, or agency
thereof (including a public housing agency); Indian tribe; and any other
organization or group of people.
Form HUD-2880 (3199)
g
Request for Taxpayer
Give form to the
Form
,Rev. October2007)
identification Number and Certification
requester. Do not
send to the IRS.
Department of the Treasury
Internal Revenue Service
Name (as shown on your Income tax return)
N
N
M
Business name, if different from above
a
C
a
Check appropriate box: ❑ IndividuaVSole proprietor ❑ Corporation ❑ Partnership
Exempt
0
jv
❑ Limited liability company. Enter the tax classification (0=d1sregarded entity, C=corporation, P=partnership) l► ._..__ _
payee
p
❑ Other (see instructions) >•
Address (number, street, and apt. or suite no.)
Requester's name and address (optional)
il. U
City, state, and ZIP code
a
fn
List account numbor(s) here (optional)
U)
EM Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3, For other entities, it is or
your employer identification number (FIN). If you do not have a number, see How to get a TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer Identification number
number to enter.
F.-artifirratinn
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I. am waiting for a number to be issued to me), and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (0) the IRS has
notified me that I am no longer subject to backup withholding, and
3. 1 am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign ISignature of
Here I U.S. person ► Mate ►
General instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business is not subject to the withholding tax on
foreign partners' share of effectively connected income.
Note. if a requester gives you a farm other than Form W-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S, person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section
301.7701-7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners' share of income
from such business, Further, in certain cases where a Form W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
Income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
following cases:
• The U.S, owner of a disregarded entity and not the entity,
Cat. No. 10231X Form VV-9 (Rev. 10-2007)
Form W-9 (Rev. 10-2007)
* The U.S. grantor or other owner of a grantor trust and not the
trust, and
* The U.S. trust (other than a grantor trust) and not the
beneficiaries of the trust.
Foreign person. If you are a foreign person, do not use Form
W-9. Instead, use the appropriate Form W-8 (see Publication
515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
Nonresident alien who becomes a resident alien, Generally,
only a nonresident alien individual may use the terms of a tax
treaty to reduce or eliminate U.S. tax on certain types of income.
However, most tax treaties contain a provision known as a
"saving clause." Exceptions specified in the saving clause may
permit an exemption from tax to continuo for certain types of
income even after the payee has otherwise become a U.S.
resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an
exemption from U.S. tax on certain types of income, you must
attach a statement to Form W-9 that specifies the following five
items:
1. The treaty country. Generally, this must be the same treaty
under which you claimed exemption from tax as a nonresident
alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that
contains the saving clause and its exceptions.
4. The type and amount of income that qualifies for the
exemption from tax.
5. Sufficient facts to justify the exemption from tax under the
terms of the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows
an exemption from tax for scholarship income received by a
Chinese student temporarily present in the United States. Under
U.S, law, this student will become a resident alien for tax
purposes if his or her stay in the United States exceeds 5
calendar years. However, paragraph 2 of the first Protocol to the
U.S.-China treaty (dated April 30, 1984) allows the provisions of
Article 20 to continue to apply even after the Chinese student
becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of
the first protocol) and is relying on this exception to claim an
exemption from tax on his or her scholarship or fellowship
income would attach to Form W-9 a statement that includes the
information described above to support that exemption.
if you are a nonresident alien or a foreign entity not subject to
backup withholding, give the requester the appropriate
completed Form W-8.
What is backup withholding? Persons making certain payments
to you must under certain conditions withhold and pay to the
IRS 28% of such payments. This is called "backup withholding.
Payments that may be subject to backup withholding include
interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee pay, and
certain payments from fishing boat operators. Real estate
transactions are not subject to backup withholding.
You will not be subject to backup withholding on payments
you receive if you give the requester your correct TIN, make the
proper certifications, and report all your taxable interest and
dividends on your tax return.
Payments you receive will be subject to backup
withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part 11
instructions on page 3 for details),
3. The IRS tells the requester that you furnished an incorrect
TIN,
Page 2
4. The IRS tells you that you are subject to backup
withholding because you did not report all your interest and
dividends on your tax return (for reportable interest and
dividends only), or
5. You do not certify to the requester that you are not subject
to backup withholding under 4 above (for reportable interest and
dividend accounts opened after 1983 only).
Certain payees and payments are exempt from backup
withholding. See the instructions below and the separate
Instructions for the Requester of Form W-9.
Also see Special rules for partnerships on page 1.
Penalties
Failure to furnish TIN. if you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such
failure unless your failure is due to reasonable cause and not to
willful neglect,
Civil penalty for false information with respect to
withholding. If you make a false statement with no reasonable
basis that results in no backup withholding, you are subject to a
$500 penalty.
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal
penalties including fines and/or imprisonment.
Misuse of T1Ns. If the requester discloses or uses TINs in
violation of federal law, the requester may be subject to civil and
criminal penalties.
Specific Instructions
Name
If you are an individual, you must generally enter the name
shown on your income tax return. However, if you have changed
your last name, for instance, due to marriage without informing
the Social Security Administration of the name change, enter
your first name, the last name shown on your social security
card, and your new last name.
If the account is in joint names, list first, and then circle, the
name of the person or entity whose number you entered in Part I
of the form.
Sole proprietor. Enter your individual name as shown on your
income tax return on the "Name" line. You may enter your
business, trade, or "doing business as (DBA)" name on the
"Business name" line.
Limited liability company (1-1-0). Check the "Limited liability
company" box only and enter the appropriate code for the tax
classification („D" for disregarded entity, "C" for corporation, "P"
for partnership) in the space provided.
For a single -member LLC (including a foreign LLC with a
domestic owner) that is disregarded as an entity separate from
its owner under Regulations section 301.7701-3, enter the
owner's name on the "Name" line. Enter the LLC's name on the
"Business name" line.
For an LLG classified as a partnership or a corporation, enter
the LLC's name on the "Name" line and any business, trade, or
DBA name on the "Business name" line.
Other entities. Enter your business name as shown on required
federal tax documents on the "Name" line. This name should
match the name shown on the charter or other legal document
creating the entity. You may enter any business, trade, or DBA
name on the "Business name" line.
Note. You are requested to check the appropriate box for your
status (individual/sole proprietor, corporation, etc.).
Exempt Payee
If you are exempt from backup withholding, enter your name as
described above and check the appropriate box for your status,
then check the "Exempt payee" box in the line following the
business name, sign and date the form.
Form W-9 (Rev. 10-2007)
Generally, individuals (including sole proprietors) are not exempt
from backup withholding. Corporations are exempt from backup
withholding for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should
still complete this form to avoid possible erroneous backup
withholding.
The following payees are exempt from backup withholding:
1. An organization exempt from tax under section 501(a), any
IRA, or a custodial account under section 403(b)(7) if the account
satisfies the requirements of section 401(f)(2),
2. The United States or any of its agencies or
instrumentalities,
3. A state, the District of Columbia, a possession of the United
States, or any of their political subdivisions or instrumentalities,
4. A foreign government or any of its political subdivisions,
agencies, or instrumentalities, or
5. An international organization or any of its agencies or
instrumentalities.
Other payees that may be exempt from backup withholding
include:
6. A corporation,
7. A foreign central bank of issue,
S. A dealer in securities or commodities required to register in
the United States, the District of Columbia, or a possession of
the United States,
9. A futures commission merchant registered with the
Commodity Futures Trading Commission,
10. A real estate investment trust,
11. An entity registered at all times during the tax year under
the Investment Company Act of 1940,
12. A common trust fund operated by a bank under section
584(a),
13. A financial institution,
14. A middleman known in the investment community as a
nominee or custodian, or
15. A trust exempt from tax under section 664 or described in
section 4947.
The chart below shows types of payments that may be
exempt from backup withholding. The chart applies to the
exempt payees listed above, 1 through 15.
IF the payment is for ...
the payment is exempt
Interest and dividend payments
FTHEN
empt payees except
Broker transactions
pt payees 1 through 13.
Also, a person registered under
the Investment Advisers Act of
1940 who regularly acts as a
broker
Barter exchange transactions
Exempt payees 1 through 5
and patronage dividends
Payments over $600 required
Generally, exempt payees
to be reported and direct
1 through 7
sales over $6,000
'See Form lo99-MISC, Miscellaneous Incomo, and its instructions,
zHowever, the following payments made to a corporation (including gross
proceeds paid to an attorney under section 6045(f), even if the attorney is a
corporation) and reportable on Form 1099-MISC are not exempt from
backup withholding: medical and health care payments, attorneys' fees, and
payments for services paid by a federal executive agency.
Page 3
Part I. Taxpayer Identification
Number (TIN)
Enter your TIN in the appropriate box. If you are a resident
alien and you do not have and are not eligible to get an SSN,
your TIN is your IRS individual taxpayer identification number
(ITIN). Enter it in the social security number box. If you do not
have an ]TIN, see Now to get a TIN below.
If you are a sole proprietor and you have an EIN, you may
enter either your SSN or EIN. However, the IRS prefers that you
use your SSN.
If you are a single -member LLC that is disregarded as an
entity separate from its owner (see Limited liability company
(LLC) on page 2), enter the owner's SSN (or EIN, if the owner
has one). Do not enter the disregarded entity's EIN, If the LLC is
classified as a corporation or partnership, enter the entity's EIN.
Note, See the chart on page 4 for further clarification of name
and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one
immediately. To apply for an SSN, get Form SS-5, Application
for a Social Security Card, from your local Social Security
Administration office or get this form online at www.ssa.gov, You
may also get this form by calling 1-800-772-1213. Use Form
W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ]TIN, or Form SS-4, Application for
Employer Identification Number, to apply for an EIN. You can
apply for an EIN online by accessing the IRS website at
wwwAs.gov/businesses and clicking on Employer Identification
Number (EIN) under Starting a Business. You can get Forms W-7
and SS-4 from the IRS by visiting www.irs.gov or by calling
1-800-TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN,
write "Applied For" in the space for the TIN, sign and date the
form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily
tradable instruments, generally you will have 60 days to get a
TIN and give it to the requester before you are subject to backup
withholding on payments. The 60-day rule does not apply to
other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to
the requester.
Note. Entering "Applied For" means that you have already
applied for a TIN or that you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign owner
must use the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person,
or resident alien, sign Form W-9. You may be requested to sign
by the withholding agent even if items 1, 4, and 5 below indicate
otherwise.
For a joint account, only the person. whose TIN is shown in
Part l should sign (when required). Exempt payees, see Exempt
Payee on page 2.
Signature requirements. Complete the certification as indicated
in 1 through 5 below.
1. Interest, dividend, and barter exchange accounts
opened before 1984 and broker accounts considered active
during 1983. You must give your correct TIN, but you do not
have to sign the certification.
2. Interest, dividend, broker, and barter exchange
accounts opened after 1983 and broker accounts considered
inactive during 1983. You must sign the certification or backup
withholding will apply. If you are subject to backup withholding
and you are merely providing your correct TIN to the requester,
you must cross out item 2 in the certification before signing the
form.
Fnrm W-3 fRev. 10-20071
3. Real estate transactions. You must sign the certification.
You may cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you
do not have to sign the certification unless you have been
notified that you have previously given an incorrect TIN. "Other
payments" include payments made in the course of the
requester's trade or business for rents, royalties, goods (other
than bills for merchandise), medical and health care services
(including payments to corporations), payments to a
nonemployee for services, payments to certain fishing boat crew
members and fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
5. Mortgage interest paid by you, acquisition or
abandonment of secured property, cancellation of debt,
qualified tuition program payments (under section 529), IRA,
Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your
correct TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
The individual
2. Two or more individuals (joint
The actual owner of the account or,
account)
if combined funds, the first
individual on the account
3. Custodian account of a minor
The minor'
(Uniform Gift to Minors Act)
4. a. The usual revocab€e savings
The grantor -trustee '
trust (grantor is also trustee)
b. So-called trust account that is
The actual owner
not a Legal or valid trust under
state law
5. Sole proprietorship or disregarded
The owner'
entity owned by an individual
For this type of account:
Give name and EIN of:
6. Disregarded entity not owned by an
The owner
individual
7. A valid trust, estate, or pensioh trust
Legal entity °
S. Corporate or LLC electing
The corporation
corporate status on Form 8832
9. Association, club, religious,
The organization
charitable, educational, or other
tax-exempt organization
10, Partnership or multi -member LLC
The partnership
11, A broker or registered nominee
The broker or nominee
12. Account with the Department of
The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
IHsi first and circle the name of the person whose number you fumfsh. If only one person
on a joint account has an SSN, that person's number must be iumished.
2Circle the minor's name and fumish the minor's SSN.
3You must show your individual name and you may also enter your business or "DnA"
name on the second name line. You may use either your SSN or EIN (if you have one),
but the IRS encourages you to use your SSN.
° List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN
of the personal representative or trustee unless the legal entity itself is not designated in
the account title.) Aso see Special rules for partmrshlps on page 1.
Note. If no name is circled when more than one name is listed,
the number will be considered to be that of the first name listed.
Page 4
Secure Your Tax Records from Identity Theft
Identify theft occurs when someone uses your personal
information such as your name, social security number (SSN), or
other identifying information, without your permission, to commit
fraud or other crimes. An identity thief may use your SSN to get
a job or may file a tax return using your SSN to receive a refund.
To reduce your risk:
* Protect your SSN,
* Ensure your employer is protecting your SSN, and
* Be careful when choosing a tax preparer.
Call the IRS at 1-800-829-1040 if you think your identity has
been used inappropriately for tax purposes.
Victims of identity theft who are experiencing economic harm
or a system problem, or are seeking help in resolving tax
problems that have not been resolved through normal channels,
may be eligible for Taxpayer Advocate Service (TAS) assistance.
You can reach TAS by calling the TAS toll -free case intake line
at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
Protect yourself from suspicious emails or phishing
schemes. Phishing is the creation and use of email and
websites designed to mimic legitimate business emalls and
websites. The most common act is sending an email to a user
falsely claiming to be an established legitimate enterprise in an
attempt to scam the user into surrendering private information
that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails.
Also, the IRS does not request personal detailed information
through email or ask taxpayers for the PIN numbers, passwords,
or similar secret access information for their credit card, bank, or
other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report
misuse of the IRS name, logo, or other IRS personal property to
the Treasury Inspector General for Tax Administration at
1-800-366-4484. You can forward suspicious emails to the
Federal Trade Commission at: spamguce.gov or contact them at
www.consumer.goit idtheft or 1-877-IDTHEFT(438-4338).
Visit the IRS website at www.irs.gov to learn more about
identity theft and how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest,
dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or
contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return.
The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S.
possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal
nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.
Indiana Housing and Community Development Authority
LHRDG Payroll Authorization Form - Recipient
Recipient: City of South Send
Award Number: LD-018-003
Please list all employees and their respective rate of pay that will be utilized on this award. If a rate of pay changes, a new
Payroll Authorization Form must be submitted. This form must be signed by the chief executive officer of the recipient and
certified by a Notary Public.
Hourly Rate of Hourly Fringe
Employee Name payBene zt ar
Pereentyge
1. $
2. $
3. $
4. $
5. $
b. $
7. $
8. $
9. $
10. $
Primary Authorized Signature
Signature
Typed Name and Title
Date
Notary Public
Subscribed and sworn before me this day of
20_
Notary Public
Typed Name
Seal:
My Commission
Expires
County of
Residence
INDIANA HOUSING AND COMMUNITY DEVELOPMENT AUTHORITY
STATE OF INDIANA
DRUG -FREE WORKPLACE CERTIFICATION
Pursuant to Executive Order No. 90-5, April 12, 1994, issued by Governor Evan Bayh, the Indiana
Department of Administration requires the inclusion of this certification in all contracts with and grants
from the State of Indiana in excess of $25,000. No award of a contract or grant shall be made, and no
contract, purchase order or agreement, the total of which amount exceeds $25,000, shall be valid unless and
until this certification has been fully executed by the Contractor of Grantee and attached to the contract or
agreement as pant of the contract documents. False certification or violation of the certification may result
in sanctions including, but not limited to, suspension of contract payments, termination of the contract
payments, termination of the contract or agreement and/or debarment of contracting opportunities with the
State for up to three (3) years,
The Contractor/Grantee certifies and agrees that it will provide a drug -free workplace by:
(a) Publishing and providing to all of its employees a statement notifying employees that the
unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in
the Contractor's workplace and specifying the actions that will be taken against employees for violations of
such prohibition; and
(b) Establishing a drug -free awareness program to inform employees about (1) the dangers of
drug abuse in the workplace; (2) the Contractor's policy of maintaining a drug -free workplace; (3) any
available drug counseling, rehabilitation, and employee assistance programs; and (4) the penalties that may
be imposed upon an employee for drug abuse violation occurring in the workplace;
(c) Notifying all employees in the statement required by subparagraph (a) above that as a
condition of continued employment the employee will (1) abide by the terms of the statement; and (2)
notify the employer of any criminal drug use conviction for a violation occurring in the workplace no later
than five (5) days after such a conviction;
(d) Notifying in writing the contracting State Agency and the Indiana Department of
Administration within ten (10) days after receiving notice from an employee under subdivision (c)-(2)
above, or otherwise receiving actual notice of a conviction;
(e) Within thirty (30) days after receiving notice under subdivision (c)-(2) above of a
conviction, imposing the following sanctions or remedial measures on any employee who is convicted of
drug abuse violations occurring in the workplace: (1) take appropriate personnel action against the
employee, up to and including termination; or (2) require such employee to satisfactorily participate in a
drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State or local
health, law enforcement, or other appropriate agency; and
(0 Making a good faith effort to maintain a drug -free workplace through the implementation
of subparagraphs (a) through (e) above,
THE UNDERSIGNED AFFIRMS, UNDER PENALTIES OF PERJURY, THAT HE OR SHE IS
AUTHORIZED TO EXECUTE THIS CERTIFICATION ON BE, OF THE DESIGNATED
ORGANIZATION.
City of South Bend
Printed Name of Organization
Signature ofAuthorized Representative
Printed Name and Title
LD-018-003
Requisition/Contract/Grant ID Number
Date
STATE FORM 44260 (R14-91)
INDIANA HOUSING & COMMUNITY DEVELOPMENT AUTHORITY
LEAD HAZARD REDUCTION DEMONSTRATION GRANT AND HEALTHY HOMES
SUPPLEMENTAL FUNDING
RESOLUTIONS
OF
City of South Bend
The undersigned, as Secretary of City of South Bend (hereinafter referred to as "the Company's"),
organized and existing under the laws of the State of Indiana, hereby attests to the making of the following
resolutions by the Company's Board of Directors. At a regular meeting of the Board of Directors, held on
with sufficient notice of the time and place of the meeting having been given and a
quorum of the Directors being present as required by the Company's bylaws, a majority of those Directors
present considered, discussed, consented to, and adopted the following resolutions:
RESOLVED, pursuant to the authority vested in the Board of Directors,
after discussion and upon motion duly made, seconded and carried, the
Company is hereby authorized to apply for and accept money in the form of
a recoverable grant from the Lead Hazard Reduction Demonstration Grant
and Healthy Homes Supplemental Funding, administered by Indiana
Housing and Community Development Authority ("IHCDA") in an amount
not to exceed Five Hundred Twenty Eight Thousand and Nine Hundred
Fifty One dollars and 01100 ($528,951.00) according to the terms and
conditions as more particularly described in Award Agreement between
IHCDA and Borrower, a copy of which is attached hereto and made a part
hereof, marked as "Exhibit A";
FURTHER RESOLVED, that the following officer(s) of the Company:
Name Title
Name Title
be and hereby are authorized, empowered and directed to execute,
acknowledge, and deliver in the Company's name and on its behalf all
applications, documents, covenants, binding real estate, deeds, instruments
or writings as are necessary and/or as appropriate to consummate the
recoverable grant transaction, as acceptable to IHCDA.
CITY OF SOUTH BEND DR20R-0I8-003
RESOLUTIONS PAGF I of 4
INDIANA HOUSING & COMMUNITY DEVELOPMENT AUTHORITY
LEAD HAZARD REDUCTION DEMONSTRATION GRANT AND HEALTHY HOMES
SUPPLEMENTAL FUNDING
RESOLUTIONS
OF
City of South Bend
ATTEST: The above resolutions are true and accurate copies of the resolutions approved on
as reflected in the Board's minutes entered in its corporate records.
Date:
Secretary,
City of South Bend
Print Name
1472412 1; MR; 08/21/09
CITY OF SoUTii BEND D1t20R-018-003
RESOLUTIONS PAGE 2 OF 4
INDIANA HOUSING & COMMUNITY DEVELOPMENT AUTHORITY
LEAD HAZARD REDUCTION DEMONSTRATION GRANT AND HEALTHY HOMES
SUPPLEMENTAL FUNDING
RESOLUTIONS
OF
City of South Bend
CriY of SOUTH BEND DR20R-018-003
RESOLUTIONS PAGE 3 OF 4
INDIANA HOUSING & COMMUNITY DEVELOPMENT AUTHORITY
LEAD HAZARD REDUCTION DEMONSTRATION GRANT AND HEALTHY HOMES
SUPPLEMENTAL FUNDING
RESOLUTIONS
OF
City of South Bend
CITY OF SOUTH BEND DR20R-018-063
RESOLUTiDNSAGB 4 OF 4
INDIANA HOUSING & COMMUNITY DEVELOPMENT AUTHORITY
LEAD 14AZARD REDUCTION DEMONSTRATION GRANT AND HE, HOMES
SUPPLEMENTAL FUNDING
OF
City of Soutar Send
The undersigned, being all of the Directors/Members of organized and
existing under the laws of the State of Indiana, (hereinafter referred to as the "Company") hereby consent
to take the following action without having a meeting. Subject to the terms, limitations and conditions set
forth below, the undersigned have considered and now adopt and approve the following resolutions, as
permitted by the Company's bylaws and by I.C. § 23-17-15-2:
RESOLVED, pursuant to the authority vested in the Board of Directors,
after due consideration, the Company is hereby authorized to take all steps
necessary to apply for and accept money in the form of a recoverable grant
from the Lead Hazard Reduction Demonstration Grant and Healthy Homes
Supplemental Funding, administered by Indiana Housing and Community
Development Authority ("IHCDA"), in an amount not to exceed Five
Hundred Twenty Eight Thousand and Nine Hundred Fifty One Dollars
and 0/100 ($528,951.00) according to the terms and conditions as are more
particularly Award Agreement between IHCDA and Corporation, a copy of
which has been provided to the undersigned;
FURTHER RESOLVED, that the following officer(s) or director(s) of the
Company:
Name Title
Name Title
be and hereby are authorized, empowered and directed to execute,
acknowledge and deliver in the Company's Marne and on its behalf all
applications, documents, covenants binding real estate, deeds, instruments
or writings as are necessary and/or as appropriate to consummate the
recoverable grant transaction, in a form and manner as is acceptable to
IHCDA.
APPROVED AND ADOPTED, this day of 20�
By: _
Name:
Title:
By:
Name:
By:
Name:
Title:
By: _
Name:
DR20R-018-003
CITY OF SOUTH BEND
PAGE 1 OF 2
RESOLUTIONS
INDIANA HOUSING & COMMUNI'JrY DEVELOPMENT AUTHORITY
LEAD HAZARD REDUCTION DEMONSTRATION GRANT AND HEALTHY HOMES
SUPPLEMENTAL FUNDING
OF
City of South Bend
Title:
By:
Name:
Title:
By:
Name:
Title:
By:
Name:
Title. -
By:
Name:
Title:
By:
Name:
Title:
1472409_1; BMI;; 08/21/09
Title:
By:
Name:
Title:
By:
Name:
Title:
By:
Name:
Title:
By:
Name:
Title:
By:
Name:
Title:
CITY OF SOUTH BEND DR20R-0) g-Oaf
RESOLUTIONS PAGE 2 OF 2
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date September 18, 2018
Name Pain Meyer Department DCI
BPW Date September 25, 2018 Phone Extension 5845
.. . . ....... . . —
mm
Controller
Purchasing
if Agreement
❑ Professional Services
❑ Bid Opening
E] Quote Opening
0 Change Order No.
F-1 Ease/Encroach.
F-1 Other:
Attorney Name Sandra Kennedy
Controller review is required for all Contracts $5,,000.00 or more and
greater than one year in length per the City Purchasing Policy
El
ie ApprcqHLa1,9 Item, Type — R6quired forAll Submissions
F1 Contract 0 Proposal E] Addendum
E] Resolution
F-1 Bid Award Req. to Advertise Title Sheet
F1 Quote Award
F-1 C/O & PCA No. F-1 PCA
[:] Traffic Control
Company or Vendor Name Indiana Housing and Community Development Authority (IHCDA)
New Vendor E] Yes Z No [:] If Yes, Approved by Purchasing
MBENVBE Contractor [-I MBE F-1 WB,E
Project Name Lead Hazard Reduction Demonstration Grant Program
Project Number
Funding Source Lead Hazard Reduction Federal Funding through IHCDA
Account No.
Amount $ 528,951.00
Terms of Contract
Purpose/Description
8/31/18-1/29/2020
To administer a program to identify and control lead -based paint hazards in
eligible privately owned rental or owner occupied housing units
[:1 Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination, Non: -Debarment, E-Verify, Iran, etc,)
Amount of F1 increase
El Decrease
Previous Amount $
Current Percent of Change
New Amount
Total Percent of Change:
0
Dispersal After Approval
Copy
Original
Pam Meyer, DCl
F-1
F
1-1
El