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HomeMy WebLinkAboutAgreement - Indiana Housing and Community Development Authority - Supplemental Disaster Recovery- Owner Occupied Rehab for LeadSUPPLEMENTAL DISASTER RECOVERY APPROPRIATION-2 COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM ("CDBG-D") AWARD AGREEMENT This is a Subaward This is Not a Research & Development Award CDFA #14,228 U.S. Department of Housing and Urban Development 100% Federal Funding Federal Award No FAIN: D-08-11)1-18-0001 Federal Award Date: Apri113, 2009 FFATA Activity Description: Owner Occupied Rehabilitation AWARD AGREEMENT NO. DR20R-018-003 THIS SUPPLEMENTAL DISASTER RECOVERY APPROPRIATION-2 COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM AWARD 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 (the "Recipient"), a Unit of Local Government, having a DUNS 4 of 074327123. WITNESSETH: WHEREAS, the Authority has been designated to receive, administer, and disburse funds pursuant to the Consolidated Security, Disaster Assistance and Continuing Appropriations Act, 2009 (Pub. L. 110-329, approved September 30, 2008) for necessary expenses related to disaster relief, long-term recovery, and restoration of infrastructure in areas affected by naturat disasters that occurred during 2008, Title I of the Housing and Community Development Act of 1974, as amended, and under regulatory waivers in the Community Development Block Grant state program granted by the HUD; and, WHEREAS, a portion of IHCDA's disaster recovery funds ("Disaster Funds") are being provided to the Recipient for eligible activities relating to the rehabilitation of owner occupied homes as identified and described in the ,Substantial Amendment to the State's Action Plan for CDBG Supplemental Disaster Recovery Funds; 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. Incororatiorr 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 One Hundred Forty Three Thousand Nine Hundred Six dollars and 00/100 Dollars ($143,906.00) of Disaster Funds (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"). Additional programmatic, statutory and regulatory requirements are attached hereto, made a pant 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 pant hereof. 3. 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 Developer at that time; CDBG--D MY OF SOUTH BEND D1220R-018-003 Recapture Page 1 of 24 (d) It shall not expend any pant of the Award for purposes other than the Project or spend more of the Award for any class of items or activities than the amount allocated for such purposes in the appropriate Iine item of the Budget, a copy of which is attached hereto, made a part hereof, and marked "Exhibit B' ; (e) It shall, froin 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, and the IHCDA CDBG & HOME Program Manual (the "Award Manual"); ( It shall promptly repay IHCDA for any CDBG funds it utilizes for expenses that are deemed "ineligible" by any of the following IHCDA, HUD, 24 CPR 570, an audit, 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 §§ 570.506 and 570.507; (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 for the greater of three (3) years fi•orn closeout of the State of Indiana's grant between HUD, or the period required by other applicable laws and regulations as described in 24 CFR 570.487 and 24 CPR §570.498. Records shall be retained beyond the prescribed period if any litigation, claim, negotiation, audit, or other action is begun involving this Agreement or the Project. In that instance, the records shall be retained until the litigation, claim, negotiation, audit, or other action has been finally resolved; (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) Except as permitted -by and in compliance with 24 CFR § 570.4890), the Recipient will not change the use or planned use of any real property within its control that was acquired or improved in whole or in part using the Award, from that for which the acquisition or improvement was made; (1) It guarantees total satisfactory performance of all work contemplated by this Agreement, and it shall tape 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 IIICDA during its monitoring and evaluation; (m) 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. 4. Term of A reement(Period of Performance. This Agreement shall be effective as of August 31, 2018 (the "Effective Date") and shall remain in effect until December 31, 2018 ("Expiration Date") except as extended by CDBG-MY OF SOUTH BEND DR20R-018-003 moo. t„ra Page 2 of 24 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. 5, Pa ymeni Schedule, The Authority shall disburse to the Recipient an amount not in excess of the Award as follows: (a) Recipient shall submit to IHCDA, at least monthly, properly completed claims for reimbursement of allowable costs incurred by Recipient under this Agreement during the prior month; (b) claims shall be submitted using IIICDA's online claim system and pursuant to instructions issued by II-ICDA. Disbursement by IHCDA is conditioned on: (x) IHCDA's receipt of all proper materials, receipts, and approvals provided herein, together with such other documentation as the Authority may, from timc to time, request; (y) requested evidence that awarded funds are being expended in proportion to expenditures of match and leverage; and (z) appropriate assurance and/or evidence satisfactory to the Authority that the Recipient is in full and strict compliance with this Agreement and the Project. 6. Pro ree ss Repoots. The Recipient shall submit progress reports to the IHCDA upon request. The report shall be oral, unless the IHCDA, upon receipt of the oral report, should deem it necessary to have it 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. 7. Comlliance 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:/Iwww.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 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 irmnediately notify the State and the IHCDA of any such actions. During the term of such actions, the Recipient agrees that IIFICDA may delay, withhold, or deny work under any supplement, amendment or contractual device issued pursuant to this Agreement. CDBG-D CITY OF SOUTH BEND DR20R-018-003 r_ _ ._ Paf4e3 of24 (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 environm®ntal statutes, rules, or regulations in the performance of work activities for the lHCDA. 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 ininimis 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 24-4.7 for the duration of this Grant Agreement, even if IC 24-4.7 is preempted by Federal law. 8. Limitations on Expenditures of Program Funds. (a) Costs associated with the environmental review, program delivery, or property acquisition may be incurred by the Recipient, at its election, prior to the effective date of the Award. This authorization to incur such costs under the Award, however, including environmental program delivery, or property acquisition casts, does not constitute a guarantee that such costs will be paid or reimbursed by the Authority. All costs incurred by the Recipient prior to the effective date of the Award and receipt of a "Notice of Release of Funds" are incurred voluntarily, at the Recipient's risk, and upon its own credit and expense. (b) Funds shall not be obligated or utilized for any activities requiring a release of funds by the State under the Enviromnental Review Procedures applicable to the CDBG 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. 9. Termination: Cancellation of Funding. (a) 'Termination. (1) The Authority may immediately suspend or terminate this Agreement if the Recipient fails to comply with any material term of the Agreement. (2) This Agreement may be terminated at any time, by either party, with or without cause, upon thirty (30) days written notice. Written notice of such termination .trust be sent to the other party by certified mail, return receipt requested, postage prepaid. After mailing of such notice of termination, no new or additional liabilities shall be incurred without the prior written approval of the Authority. (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 DR2OR CDBG-D CITY OF SOUTH BEND T'aec 4 3 _ 4 of 24 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 f uids are not available to support continuation of performance of this Agreement, the Agreement shall automatically terminatc. Any determination by the Executive Director of MCDA or the Director of the State Budget Agency that hinds 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 IHCDA. 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. (c) 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. 10, 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 IH- DA 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. 11, 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) To the Recipient: City of South Bend 227 West Jefferson Avenue- Suite 1400 N South Bend, IN 46601 Attention: RTCDA Award Administrator (b) To the IIICDA: Indiana Housing and Community Development Authority 30 South Meridian Street, Suite 900 CDB G-D MY OF SOUTH BEND DTt20R-0 [ 8-003 Page 5 of 24 Indianapolis, IN 46204 Attention: CDEG- DR-2 With a copy to: David Stewart, General Counsel Indiana Housing and Community Development Authority 30 S. Meridian Street, Suite 900 Indianapolis, IN 46204 (c) Awarding Official: IHCDA J. Jacob Sipe, Executive Director 30 S. Meridian Street 900 Indianapolis, IN dSipe(-}a,ihcda.IN. Gov The parties may change the foregoing notice addresses by providing notice of such change to the other parry in accordance with this Section 11. 12. 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 Dorm-LLL, "Disclosure Form to Report Lobbying", in accordance with its instructions. 13. 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 IIdCDA 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 CFR. 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. 14. 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 1HCDA 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. CDB&D CITY OF SOUTH BEND DR20R-018-003 j Pan 6 of 24 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 -flee 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 Recipient'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 Recipient'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 employee 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 fiom 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 (t) Making a good faith effort to maintain a drug -free workplace through the implementation of subparagraphs (a) through (e) above. 15. Independent 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 as provided 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 emissions of the agents, employees, or subcontractors of the other party. 16. Work Standards. The Recipient shall each execute its responsibilities by following and applying at all times the highest professional and teelmical 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 17. Assurances and Certifications, The Recipient agrees to comply with the "Assurances and Certifications" set forth iii Exhibit C. Those "Assurances and Certifications" are fiiIly incorporated herein, and made a part hereof by reference. Any material inaccuracy of any representation or warranty contained thercin shall constitute a material breach of this Agreement, for which the Authority may terminate this Agreement. The Recipient further certifies that it wiII comply with the requirements and standards of all applicable provisions in the following: (a) Post federal award requirements in 2 CPR 200 Subpart D, Cost principles in 2 CFR 200 Subpart E, and Audit Requirements set forth in 2 CFR 200 Subpart P; and .(b) Subpart K — Other Program Requirements, 24 CFR §§ 570.601 to 570.614. CDBG-D CITY OF S TTJTH BEND DR20Jt 018-003 Jtecapture Page 7 of 24 18. Audits, The Recipient shall submit to an audit of funds paid through this Agreement and/ or an onsite monitoring review of the Proj ect by IIICDA or its designee. The Recipient shall make all books, accounting records and other documents available at all reasonable times during the 'Perm of this Agreement and for the greater of three (3) years from closeout of the State of Indiana's grant between IIUD, or the period required by other applicable Iaws and regulations as described in 24 CFR 570,487 and 24 CFR §570.488. Records shall be retained beyond the prescribed period if any litigation, claim, negotiation, audit, or other action is begun involving this Agreement or the Project. Copies shall be furnished to the IHCDA at no cost. (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 Norm 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: (l) 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. 19. Federal Fundin Ability and 'I'ranspareney Act of 2006 (:"F111 TA" . In accordance with 2 CFR 200.300(b), FFATA zeporting 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--reeipient, must provide any information needed pursuant to these requirements. This includes entity infon�nation, the unique identifier of the Recipiennt, 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 Numbering System DUNS number. Pursuant to FrATA 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 witbin 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 htt p://fed ov.dnb.com/webforru (b) 5ynem £or Award Mara cment SAM . The Recipient shall register in the System for Award Management ("SAaV1"), 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 informatinn at least annually after the initial registration, and maintain its status in the SAN1 through the Expiration Date of this Agreement. Information regarding the process to register in fine SAM can be obtained at https•//www.sam.gov/portall-puhliclSAMI. (c) Executive Compensation. The Recipient shall report the names and total compensation of the five (5) most highly compensated officers of Recipient in SAKI if the Recipient in the preceding fiscal year received eighty percent po/o) 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 rovenues from 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 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), 780(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 CDBG-D CITY OF SOUTH BEND DR20R 018-003 Page 8 of 24 executive compensation data into the SAM under FFATA, provided, that the Recipient shall still register and submit the other data requested. 20. Indirect Cost Rate.__According to 2 CFR 200.4J4(f), the Recipient may charge a de rninirnis 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 for 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 IX 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. 21. Em to ment Eli ibilit 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 farther agrees that: 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. 22. Governin Law. This Agreement shall be construed and governed in accordance with the laws of the State of Indiana. The parties agree to submit to the exclusive jurisdiction and venue of the courts of Marion County, Indiana for any action arising out of this Agreement. 23. 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. 24. 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 party's right to enforce such provision in the future. 25. Publicity. 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. 26. Severabilit . The invalidity of any provision of this Agreement shall not invalidate the remaining provisions of this Agreement. 27. Exhibits. Exhibits A, B, C and Appendix A are attached hereto are fully incorporated herein. 28. 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, (4) the Application, and (5) the Exhibits prepared by the Recipient. CDBG-D QTY OF SOUTH REND DR20R 018-003 Page 9 of 24 Non -Collusion an(I Acceptance The undersigned attests, subject to the penalties for perjury, that the, undersigned is the Recipient or that the undersigned is the properly authorized 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 sum 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 IHCDA have, tbro-ugh their dryly authorized representatives, entered into this Agreement, The parties, having read and understood the foregoing terms of this Agreement, do by their respective signatures dated below hereby agree to the terms thereof, APPROVILI) City of Sou&IsrQdOf 11,ajkjic Indiana Housing and Community Development Authority; Printed Name: J. Jacob Sipe Title: Yxq2cutivc Date: DR20R-018-003 -dD T�DC]f'7YOFSOUFH�E�'M Pape 10 of 24 EXHIBIT A ADDITIONAL. PROGRAMMATIC, STATUTORY AND REGULATORY REQUIREMENTS Agreement Number: DR20R-018-003 Recipient: City of South Bend Funding Source/Activity Type: CDIIG -D The award recipient is bound by the contents of the Indiana Housing and Community Development Authority's (IHCDA's) Community Development Block Grant application package, CDBG Award Manual, FSP Memos, 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, PROGRAM INCOME, Program income, as defined in 24 CFR § 570.500(a), received by the Recipient is to be returned to the Authority upon expiration and/or Closeout of the Award. CLOSEOUT A. The Recipient must submit, no later than the Expiration Date, all financial, performance infoirination 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 1HCDA 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. Real property requirements set forth in 24CFR 570.505 and 2 CFR 2000) and requirements reIatad to program income in 24 CPR 570.504. S. Records retention requirements as set forth herein. PUBLIC ACCESS TO PROGRAM RECORDS Notwithstanding 2 CFR 200.337, the Recipient shall provide citizens with reasonable access to records regarding the past use of CDBG funds, consistent with applicable State and local laws regarding privacy and obligations of confidentiality. INELIGIBLE COUNTIES The Recipient agrees and understands that the ten (10) counties, listed below, are ineligible to receive and/or utilize CDBG- D funding and are ineligible areas for the Recipient to conduct any activities related to the Project. Accordingly, the Recipient will be required to repay 11HCDA for any costs incurred for any part of the Project undertaken in any of the counties, listed below. Blackford Clinton Delaware Howard Lagrange Miami Steuben Tipton Warren Wells AI+FORDABILITY PERIOD DR20R-0I CDBG-D CITY OF SOUTH BrND off r Pale 11 of 24 The Recipient must ensure that a lien is executed and recorded on every property that receives assistance through the Project. The Recipient must execute a lien and restrictive covenant prepared by IHCDA. The affordability period for a property starts at the time that the Recipient submits its completion reports for that property to IHCDA and these reports are approved. Therefore, it is in the homeowner's best interest for the Recipient to submit the completion reports to IHCDA as soon.as possible. RECAPTURE OF ASSISTANCE Recapture Event, if any of the following events occurs, IHCDA will recapture the amount of amount of eligible CDBG-D funding associated with the rehabilitation including, ER, Lead and Program Delivery. A. the homeowner transfers or conveys the property by deed, land contract, or otherwise; B, foreclosure proceedings are commenced against the property; C, the Real property is transferred by an instrument in lieu of foreclosure; or D. the title to the property is transferred from the homeowner through any other involuntary means. However, if the property is transferred or conveyed to a new owner, who meets the income requirements associated with the Project [income documentation must be approved by IHCDA], agrees to execute a lien and restrictive covenant prepared by IHCDA and use the property as his or her principle residence for the remainder of the affordability period, no recapture of CDBG-D funds are required. If the homeowner passes away during the affordability period, the lien still must be paid off like any other mortgage or lien, however if the property is sold to another low income family who is willing to maintain a lien on the property for the remainder of the affordability period and use the property as his or her principle residence, no recapture of funds is required. Once the homeowner dies the lien will not be forgiven past that date. AMOUNT OF RECAPTURE The amount to be recaptured shall be shall be reduced on a pro rata basis, by dividing the amount of time the homeowner(s) has used the housing for a principal residence during the Affordability Period by the total amount of time in the affordability period If there are not any proceeds, there is no amount to recapture. The net proceeds are the total sales price minus all loan and/or lien repayments. The forgiveness ratio is the ratio that calculates the amount of the subsidy that is forgiven. This ratio shall be calculated at the time of a Recapture Event, by dividing the number of full months that owner occupies the property as its principal residence by the total of number of months in the affordability period, The Recipient is ultimately responsible for repaying IHCDA for any CDBG-D funds utilized for any housing rehabilitated, or repaired that does not remain affordable for the entire affordability period. NON-COMPLIANCE. Non-compliance occurs during the affordability period when any of the following occur: 1) the homeowner no longer occupies the property as his or her principal residence (i.e., the property is rented or vacant), or 2) the property was sold during the affordability period and the recapture provisions were not enforced and/or neither IHCDA nor the Recipient received notice. In the event of noncompliance, the owner must repay the entire amount of the CDBG-D funds that were invested into the property. Net Proceeds ("as defined above") and the forgiveness are not applicable when there is a non- compliance. THERE, FORE•, IT IS IMPERATIVE THAT THE OWNER DOES NOT ABANDON OR LEASE THE PROPERTY DURING THE AFFORDABILITY PERIOD. FORM OF ASSISTANCE The Recipient must provide this award as a recoverable grant, amortized loan, or deferred loan directly to the beneficiary, LEVERAGING FUNDS There is a Can percent (10%) leveraging requirement for the Award. Proposed leveraging funds should be expended on a pro rata basis with CDBG-D funds to the greatest extent possible. Documentation of eligible leveraging funds expenditure must be submitted to IHCDA with completion reports. In the event an award, considered as eligible CDBG-D leverage, is not made to the housing activity, the Recipient must provide verification of an alternate source of CDBG-D leverage funding. In the event an eligible source of funding is not secured, all funds under this Agreement will be recaptured by IHCDA. CDBG-D CITY OF SOUTH BEND DR20R 018-003 Pave 12 of 24 Contributions of volunteer labor and materials may not be taken into account as such when determining the lowest bid; the total bid (including all volunteer contributions) must be used. Contributions of volunteer labor and materials must be documented. Receipts or comparable documentation of price of donated materials must be provided. Volunteer hours must be documented by actual labor hours expended per housing activity at the usual rates of pay for skilled workers or $10 per hour for unskilled workers. Any eligible leverage used for the Award will be documented. These eligible sources of leverage may be used or shared to meet requirements for a future housing activity. Please contact your IHCDA Real Estate Production Analyst to discuss eligible forms of mateb/leverage. DAMS -BACON The Davis -Bacon Act requires that workers on certain federally assisted housing activities receive no less than the prevailing wages being paid for similar work. Prevailing wages are computed by the U.S. Department of Labor and are issued in the form of a federal wage determination for each classification of work. The Davis -Bacon Act applies to awards for the following activities that are funded in whole or in part by CDBG-D funds: (1) the rehabilitation or new construction of residential property containing a total of eight (8) or more units (this includes both assisted and non -assisted or market rate units); or (2) the construction, alteration and/or repair, or painting of a public building or facility; or (3) any construction work on non-residential property valued at more than $2,000.00. Therefore, if CDBG-D funds finance only a portion of the construction work, labor standards are applicable to the entire project. If the Project meets any of the criteria described in the paragraph above, the Recipient certifics that it will comply with the Davis Bacon. Act and include the Davis Bacon Provisions contained in HUD Form 4010 and referenced in Exhibit D of this Agreement into all contracts with any contractor working on the Project currently or hereafter. Accordingly, Recipient and or any contractor working on the Project shall pay approved Davis Bacon wages weekly to employees and/or subcontractors, monitor the compliance of contractors and subcontractors working on the Project, ensure that WH347 forms and/or certified payrolls are submitted to any designee of IHCDA for labor standards monitoring, ensure that contract and bid specifications contain the applicable wage decision, verify that contractors are not listed on federal Excluded Parties List System (EPLS) for debarred or suspended contractors, and comply with the posting and notification requirements set forth in 29 CFR 5.5(a) and 29 CPR 5.6. The Recipient is responsible for contacting its IHCDA Compliance Monitor to ascertain whether Davis -Bacon wages are required. If Davis -Bacon is applicable, the Recipient may contact its IHCDA Compliance Monitor to set up a pre - construction conference. MEANINGFUL ACCESS I+OR LIMITED ENGLISH PROFICIENT PERSONS 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-D funds or DR-2 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. UNII+ORM RELOCATION ACT Commitment of funds to housing activities for any acquisition, rehabilitation, demolition, purchase assistance, and/or relocation activities is conditioned upon IHCDA verification of compliance with the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (URA), as amended, and the implementing regulations at 49 CPR Part 24. SUBSTANTIAL RECONSTRUCTION/REPLACEMENT HOUSING DBG D CITY OF SOUTH 13BND DR20R 018-003 Pape 13 of 24 Proposed reconstruction or demolition and replacement of units must be approved by IHCDA prior to the commitment of funds. Manufactured replacement housing requires specific approval as well. Refer to IFICDA's Substantial Reconstruction Policy for detailed requirements. MIZE N PARTICIPATION The Recipient must conduct at least two (2).public hearings, for the purpose of obtaining citizens' input and formulating or responding to proposals and questions about the Project. The first hearing should be conducted before the Recipient submits its application. The second hearing must be conducted after the Project is completed but before the Recipient submits its closeout documents. 'Together, the hearings must address community development and housing needs, development of proposed activities and review of program performance, A legal notice must be published to announce the meeting and the minutes of the meeting must be retained by the Recipient. It is acceptable to conduct the hearing during any regularly held public meeting, such as a town council meeting, provided all other requirements are met. Recipient must conduct the hearings in accordance with the guidance set forth in the Award Manual. The Recipient shall establish procedures for responding to citizen's complaints regarding the activities carried out utilizing these funds. Citizens should be providing with at'i appropriate address, phone number, and times during which they may submit such complaints. The Recipient should provide a written response to every citizen complaint within fifteen (15) working days of the complaint. RELIGIOUS ORGANIZATIONS Organizations that are religious or faith -based are eligible, on the same basis as any other organization, to participate in the CDBG program. Organizations that are directly funded under the CDBG program -may not engage in inherently religious activities, such as worship, religious instruction, or proselytization, as part of the assistance funded under this part. If an organization conducts such activities, the activities must be offered separately, in time or location, from the assistance funded under this part, and participation must be voluntary for the beneficiaries of the assistance provided. A religious organization that participates in the CDBG program will retain its independence from Federal, State, and local governments, and may continue to cant' out its mission, including the definition, practice, and expression of its religious beliefs, provided that it does not use direct CDBG funds to support any inherently religious activities, such as worship, religious instruction, or proselytization. Among other things, faith -based organizations may use space in their facilities, without removing religious art, icons, scriptures, or other religious symbols. In addition, a CDBG-funded religious organization retains its authority over its internal governance, and it may retain religious terms in its organization's name, select its board members on a religious basis, and include religious references in its organization's mission statements and other governing documents. An organization that participates in the CDBG program shall not, in providing program assistance, discrirnivate against a program beneficiary or prospective program beneficiary on the basis of religion or religious belief. CDBG funds may not be used for the acquisition, construction, or rehabilitation of structures to the extent that those structures are used for inherently religious activities. CDBG funds may be used for the acquisition, construction, or rehabilitation of structures only to the extent that those structures are used for conducting eligible activities under this part. Where a structure is used for both eligible and inherently religious activities, CDBG fiords may not exceed the cost of those portions of the acquisition, construction, or rehabilitation that are attributable to eligible activities in accordance with the cost accounting requirements applicable to CDBG funds in this part. Sanctuaries, chapels, or other rooms that a CDBG funded religious congregation uses as its principal place of worship, however, are ineligible for CDBG-funded improvements. Disposition of real property after the term of the grant, or any change in use of the property during the term of the grant, is subject to government -wide regulations governing real property disposition (.see 2 CPR 200.311). LEAD-l3ASED 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 CPR part 35, subparts A, B, H, 7, K, M, R, and 40 CPR 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 (mown lead -based paint hazards to prospective tenants before the lease is signed, CDBG-D CITY OF 50I)TH BEND DR20R-018-003 Page 14 of24 3. Performance of a risk assessment for deteriorated paint, 4, Stabilization of deteriorated fainted surfaces and performance of hazard reduction activities, 5. Notification of tenants each time such an activity is performed, 6. Conducting all work in accordance with I-RM safe practices, 7. Maintaining records concerning paint stabilization by owners of deteriorated paint. 8. Performing clearance examinations after paifit stabilization and before re -occupancy. 9. Performing ongoing lead -based paint maintenance when there is an ongoing relationship with ERM. 10. If the Recipient is notified by a public health department or other medical health care provider, or verifies information from 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. SECTION 3 I2T+u UIREMI;NTS Any recipient receiving an aggregate amount of $200,000 or more from one (1) or more of the HUD CPD programs (i.e. CDBG, HOME, NSP, HOPWA, ESG, etc) in a program year must comply with the Section 3 requirements. Section 3 provides preference to low- and very -low-income residents of the local community (regardless of race or gender) and the businesses that substantially employ these persons, for new employment, training, and contracting opportunities resulting fi-om HUD -funded projects. MBEIWBI The Recipient shall exercise their "best efforts" to ensure that MBE/WBE's are given the opportunity to participate in CDBG funded contracts, including contracts for services, supplies and construction activities. Indiana has adopted a goal of ten percent (10%) aggregate participation for minority- and/or women -owned business enterprises in CDBG funded projects. The Recipient must maintain documentation supporting their "best efforts" for monitoring and auditing purposes. The Recipient must document solicitation of MBE/WBE firms through Certified Mail receipts, Certificates of Mailing, receipts from hand -delivery of notices, or email. For email notification, the Recipients should use a `delivery receipt' and/or `read receipt' function on the email and maintain a copy of both the email and the verification that it was delivered and/or opened. FAIR HOUSING The Recipient roust 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, commnunity 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 be cause for lHCDA 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 CONFIDENTIALITY The 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. § 4-1-1I. 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. CDBG-D MY OF SOUTH BEND DR20&-018.003 Page 15 of 24 BONDINQ REQUIREMENT For any construction contracts or subcontracts exceeding $100,000, the following is required: A. A bid guarantee from each bidder equivalent to five percent (5%) of the bid price, The "bid guarantee" shall consist of a fine 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 pail of the contractor for one hundred percent (1001/1o) 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 fiom companies holding certificates of authority as acceptable sureties pursuant to 31 CFR part 223, "Surety Companies Doing Business with the United States." LIED 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. 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. 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 officer's, 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, local 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 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. CDBG-D CITY of SOUTII BEND DR20R 018 OQ3 _ Page 16 of 29 CONFLICT OF IN L' IMEST 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 law 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 rnainfain 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. D. Take prompt action when instances of noncompliance are identified including noncompliance identified in audit findings. E. 'fake reasonable measures to safeguard protected personally identifiable information and other information that IHCDA or IIUD designates as sensitive or the Recipient considers sensitive consistent with applicable Federal, state, local, and tribal laws regarding privacy and obligations of confidentiality. CDBG-D CITY OF SOUTH BFND DR20R 018-003 Pave 17 of 24 1 EXHIBIT B BUDC,14 Agreement Number. DRZOR-018-003 Recipient: City of South Bend Funding Source/Activity Type: CDBG -D Bud et sine -Item Total Allowable Amount Contract for Hazard Control Work $118,750 Staff Su oit $10,161 Personnel Direct Labor)--$6,250 Frin eBenefits $8,745 Total Match $143,906 CDBG-D CRY OF SOUTH BEND DR25FO18-003 Recapture Page 18 of24 CONSTRUCTION SCHEDULE RECIPIENT MUST .INDICATE THE' MONTH AND YEAR THESE BE' NCHMARKS WILL BE COMPLETED WITHIN THE TERM. OF THE AWARD Effective date Aunust 31,201 Expiration date December 31,201 ACTIVITY Pereenta e Pereenta e of funds drawn on November 1, 2018 Recipients will be required to explain the cause of any delay(s) and provide a detailed timeline. Nat meeting these benchmarlu could result in de -obligation of funds and will be W(en into consideration on future applications with a possible deduction of points. Meeting or exceeding benclunarks will be taken into consideration with possible bonus points L A13G D CiTY OP s OUTII BEND 17R20R 018 003 ecapture Page 19 of24 EXIT BIT C CIIBG-I) ASSURANCES AND CERTIFICATION The Recipient or Borrower 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 or Borrower to act in connection with this Agreement and to provide such additional information as may be required. 3) It has complied with all requirements of Executive Order 12372, and that either: A. Any comments or recommendations made by or through clearinghouses are attached and have been considered prior to submission of the application; or B. The required procedures have been followed and no comments or recommendations have been received prior to submission of the application. 4) It has facilitated or will facilitate citizen participation by: A. Publishing a statement of proposed activities so that affected citizens have an opportunity to submit comments on the proposed activities and community development performance of the Recipient or Borrower; B. Providing adequate notices for two or more public hearings, specifically to persons of low and moderate income; C. Holding two or more public hearings on the proposed application at times and locations convenient to potential beneficiaries, convenient to the physically disabled, and meeting needs of non-English speaking residents, if appropriate, to obtain citizens' views before adoption of a resolution or similar action by the local governing body authorizing the filing of the application; D. Providing citizens information concerning the amount of funds available for proposed community development activities and the range of those activities; E. Providing citizens with information concerning the amount of funds that will benefit persons of low and moderate income; F. Furnishing citizens with the plans made to minimize the displacement of persons and to assist persons actually displaced as a result of program activities; G. Providing technical assistance to groups representing persons of low and moderate income requesting such assistance in developing proposals; H. Providing citizens with reasonable notice of substantial changes proposed in the use of program funds and providing opportunity for public comment; 1. Providing citizens with reasonable access to records regarding the past use of CDB G funds received; and L Ensuring that any modifications or amendments of the program that are made from time to time will be made in accordance with the same procedures required in (d) for the preparation and submission of a statement of proposed activities. 5) It has developed a community development plan, which at a minimum, A, Identifies the Recipient or Borrower's community development needs and housing needs; and B, Specifies both the shorn -tern and long-term community development objectives that have been developed in accordance with the primary objectives of 24 CFR Part 570, 6) The Community Development program has been developed to give maximum feasible priority to activities which will benefit low and moderate income families, or aid in the prevention or elimination of slums or blight. 7) It will minimize displacement of persons and provide for reasonable benefits to any person involuntarily and permanently displaced as a result of activities associated with program funds. DR18-0 CDBG-D CITY OF S P ase20of24 OUTII BEND aae I 8) It will not attempt to recover any capital costs of public improvements assisted in whole or part with CDBG funds by assessing any amount against properties owned and occupied by persons of low and moderate income including any fee charged or assessment made as a condition of obtaining, access to such public improvements, unless (i) CDBG funds received are used to pay the proportion of such fee or assessment that relates to the capital costs of public improvements that are financed from revenue sources other than CDBG funds; or (ii) for purposes of assisting any amount against properties owned and occupied by persons of low and moderate income who are not persons of very low income, the borrower certified to the Secretary or such State, as the case may be, that it lacks sufficient funds received from the CDB G Program to comply with the requirements of clause. 9) It will comply with all requirements unposed by the State concerning special requirements of law, program requirements, and other administrative requirements approved in accordance with OMB Circular No. A-102, Revised, which includes a provision that program or project completion be no later than eighteen (18) months from project startup, inclusive of the bid process for professional and engineering services and program close-out. 10) It Will comply With: A. Section 110 of the Housing and Community Development Act of 1974, as amended, by the Housing and Urban - Rural Recovery Act of 1983 and the Housing and Community Development Act of 1987, 24 CFR 570.603, and State regulation regarding the administration and enforcement of labor standards; B. The provisions of the Davis -Bacon Act (46 U.S.C. 276a-5) which prescribe prevailing wage rates for construction trades for all projects except residential structures of less than 8 units; C. Contract Work Hours and Safety Standards Act of 1962, 40 U.S.C. 327-332, requiring that mechanics and laborers (including watchmen and guards) employed on .federally assisted contracts be paid wages of not less than one and one-half times their basic wage rates for all hours worked in excess of forty in a Work -Week; D. Federal Fair Labor Standards Act, 29 U.S.C. 102, requiring that covered employees be paid at least the minimum prescribed wage, and also that they he paid one and one-half tinges their basic wage rate for all hours worked in excess of the prescribed work -week; and E. Anti -kickback (Copeland) Act of 1934, 18 U.S.C. 874 and 40 U.S.C. 276c, which outlays and prescribes penalties for "kickbacks" of wages in federally financed or assisted construction activities. 11) It will comply Witt]: 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 or Borrower 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 or Borrower, this assurance shall obligate the Recipient or Borrower, 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 affrrinatively further fan' 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 CDBG-D MY OF SOUM BEND DR20R 018-003 Pape 21 of24 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. 12) 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. 13) It will comply with the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended, and Federal implementing regulation at 49 CFR Part 24, and the requirements of Section 570.496a and it is following a residential anti -displacement and relocation assistance plan under section 104(d) of Title I of the Housing & Community Development Act of 1974, as amended. 14) 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 wham they have family, business or other ties. 15) It will abide by the provision that no member, officer, or employee of the borrower or its designees or agents, no member of the governing body of the locality in which the program is situated, and no other public official of such locality or localities who exercise any functions or responsibilities with respect to the program during the tenure or for one year thereafter shall have any direct or indirect interest in any contractor, subcontractor, or the proceeds thereof, financed in whole or in part with Title I grants. 16) It will comply with the provisions of the Hatch Act which limits the political activity of employees. 17) It will give the State, IHCDA, IM and the Comptroller General, through any authorized representatives, access to andm the right to examine all records, books, papers, or docuents related to the loan. 18) Its chief executive officer or other officer of the Recipient or Borrower approved by the Indiana Housing and Community Development Authority: A. Consents to assume the status of a responsible Federal official under the National Environmental Policy Act of 1969 (NEPA) (42 U.S.C. 4321) and other provisions of Federal law, as specified at 24 CPR 58.1 (a)(3) and (a)(4); and B. Is authorized and consents on behalf of the Recipient or Borrower to accept the jurisdiction of the Federal courts for the purpose of enforcement of responsibilities as such an official. 19) 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 Environnental 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: i. ConsuIting 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 effects (see 36 CFR 800.8) by the proposed activity, and ii. CompIying with all requirements established by the State and to avoid or mitigate adverse effects upon such properties. B. Executive Order 11988, Floodplain Management; C. Executive Order I1990, 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); CDBG-D CTrY OF SOUTHBBEND DR20R 018-003 Nee22 of 24 G. The Safe Drinking Water Act of 1974, as amended, (42 U.S.C. 7401); H. Section 40.1(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 20�(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. 20) It will comply with all parts of Title I of the Housing and Community Development Act of 1974, as amended. 21) It will comply with the provisions of the Indiana Code (I.C.) 35-44-1-3 and 4. 22) 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. 23) 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. 24) It certifies that it has adopted and will enforce a policy of prohibiting the use of excessive force by law enforcement agencies within its jurisdiction against any individuals engaged in nonviolent civil rights demonstrations; and enforcing applicable State and local laws against physically barring entrance to or exit from a facility or location which is the subject of such non-violent civil rights demonstrations within its jurisdiction (Section 104(l) of the Housing & Community Development Act of 1974, as amended). 25) It certifies that pursuant to 31 U.S.C. 1352, and any regulations promulgated thereunder: A. No federal appropriated funds have been paid or will be paid, by or on behalf of the Recipient or Borrower, 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 proposed Federal contract, grant, loan or cooperative agreement, the Recipient or Borrower shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. C. The Recipient or Borrower shall require that the language of this certification be included in the award documents for all sub awards at all tiers (including subcontracts, sub grants, and contracts under grants, loans, and cooperative agreements) and that all sub recipients shall certify and disclose accordingly. 26) Recipient or Borrower hereby authorizes IFICDA 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 IIdCDA at any time on or after the date of this Recipient or Borrower without any limitation whatsoever. Recipient or Borrower understands that: (i) it is relinquishing any and all ownership rights in any such photograph, pictrure or medium to 7HCDA; 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 IHCDA. 27) Neither the Recipient or Borrower, nor its principals or 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. CDDG-D C1TY OF SOUTH BEND DR20R-018-003 . -- ---- Paae23of24 I/We, Appendix A Duplication of Benefits Affidavit ("Affidavit") affirm the following: I/We own real property at (City/Town), Indiana (the "Residence") which is located in an area that was impacted by the floods of2008. I/We is/are executing this Affidavit in connection with the rehabilitation of the Residence by �. (Organization) through a homeowner rehabilitation project funded under the Indiana Housing and Community Development Authority's ("IHCDA's") Weatherization Owner -Occupied Rehabilitation Program (the "Program"). 3. In addition, UWe have received or will receive the following amounts and types of assistance from the sources listed below ("Duplicative Assistance") for the rehabilitation of the Residence, structural repair of the Residence or replacement housing: a. Insurance (Flood Insurance, Homeowner's, etc.) $ b. Federal Emergency Management Agency (FEMA) c. Small Business Administration (SBA) Loan $ d. The American Red Cross (Red Cross) $ e. Other agencies (besides IHCDA) $ _ 4. I/We have received no other assistance funds in the for rehabilitation of the Residence, structural repair of the Residence or replacement housing other than that set forth above in paragraph 4. 5. 42 U.S.C. 5155(a) prohibits federal agencies from providing assistance to any person for "any part of such loss" as to which he has received financial assistance under any other program or from insurance or any other source ( such as, FEMA, SBA, Insurance, etc.). 6. I/We understand that the amount of assistance received by I/We from IHCDA must be reduced by the amount of Duplicative Assistance received or will be received for rehabilitation of the Residence, structural repair of the Residence or replacement housing, from other sources (such as, FEMA, SBA, the Red Cross, homeowner's insurance, etc.) for the same purpose. 7. Therefore, I/We understand that if I/We receive assistance from a source other than IHCDA (such as, FEMA, SBA, the Red Cross, homeowner's insurance, etc.) for the rehabilitation of the Residence, structural repair of the Residence or replacement housing, I/We must repay the assistance received from IHCDA. 8. I/We certify under State and Federal penalties for perjury and fraud that the information provided above is true and accurate and acknowledge that repayment of all assistance received by Me/Us from IHCDA, payment of fines and/or imprisonment may be required in the event that I/We provide false, incomplete or misleading information in this Affidavit or during the rest of this process. Property Owner Signature of Property Owner Date Property Owner Signature of Property Owner Date CDBG-D C1TY OF SOUTH BEND DR20t- 018-003 Recapture Page 24 of 24 DESCRIPTION OF DOCUMENTS INCLUDED IN YOUR AWARD PACKAGE The following is a list of the forms/documents that may be included within your agreement packet and an explanation of their purpose(s): o Authorized Contact Form— Provides IHCDA contact information for individuals that you are authorizing IHCDA to contact regarding your organization's award. m Authorized Signature — Provides IHCDA with the list of individuals that are authorized by your organization to execute agreements and binding forms on behalf of your organization. o ACH Authorization Form — Provides your organization's bank account information to facilitate the transfer of funds. ® Award Agreement --- Binds you and your organization to the requirements associated with the award. p Exhibit D (HUD Form 4010j — Explains requirements regarding Davis Bacon, including requirements for sub --contractors involved inapplicable projects. o HUD Disclosure Form — Used in CDBG-D grants to prevent fraud, waste, abuse, and conflicts of interest. • W-9 — Collects tax information so that IRS reporting requirements can be met. • Payroll Authorization Fora -- Provides to IHCDA a list of each employee being paid out by this award, along with their hourly rate of pay. • Drug Free Certification —Serves as a binding agreement that your organization will provide a drug free workplace. • Resolution — Provides evidence that your organization consented to a resolution involving the application and receipt of funding from, IHCDA: Which Resolution Form Generally with Some Exception o Short Form: Use if the Board has met prior to the time the application was submitted and approved the actions that were going to be taken. o Lqi g: Use if the Board must convene after the application was submitted to approve the receipt of the funds and pass the resolution. [00016885-2} Indiana Housing and Community Development Authority Authorized Contact Information Form Please indicate below the name(s) of the authorized contact person(s) for this award. This is the individual that lHCDA will contact should we have any questions regarding this award. Applicant: Award Number: City of South Bend DR20R-018 -003 Applicant Contact Name: Organization: Title: Email Address: Sub recipient Contact Dame: Organization: Title: Email Address: Administrator Contact Name: Organization: Title: Email Address: Signed: Authorized Signatory of Applicant Title Date of Signatwe Phone Number: Phone Number: Phone Number: -r-- Tudiaua Mousing Coiiiiiiiiiiity'Develol)jneii-L Authority HICDA Approval (11111CDA") Recipient Autborized Signature Porn] Saininflia Spergel Director Real Estate Production Hereby authorizes any of the f011Owiog of individuals whose. autheinicated signatures 'Fliisfonnititistbeapprovcdbydiupyiinm a"flioiizedsignatoxyaiideaclisi,-ilahiTeintistbe appear Oil this form w Sign contracts, agceenjents, ainondrucing, modifications, and /Y acknoNvIedged by a Notary Public ACH Authorization Forins for awards on behalf Dnte of Recipient, Accordingly, any contacts, agreements, mrienchnents, modifications, and CITY OFSOUDIBEND ACH Authorization Forms executed by any of the individmfl4�j'j#WjftVa binding DRZOI�-018-003 upo Re ient B Priors e Mike- I —to ry Authorized Signatory —A U" t h 0 —riz c d Signatory Authorized Signatory Y4 ryXiaborl signar1re signahn a Signature e are --F) —ped Msa 1 —0 Type d I We ed Title jTj,,d Mj� Date Notary Public Notary Public Notary Public Notary Public Subscribed and nvow, before me dpis_day of Subscribed and sYvom before me this _ dfty of SubscAcd mid sworn before une this _day of Subscribed and sworn before me this.-- day of 20 20 e 20 2o.— Notary publia ,___ —r--' --- Ariaue , I ­­ F_ '—----"—Tyj"d"�nd A 1�jjad,%Iamc Y"d y"d'y""' I _ _i' _,_ — — 'yPires -es � My cannnissionr L :Ylj fj my Commission b xpiles my Conanission L Coanty qfResidence Co""'J' ojj7 Comay DfResidence County ofResidevee Seal; Seal: a I Tliis dcournent supersedes all otijar authorizatiouS and shall continue in force until expiration of aw' ard(s) or a new authorization has been received. Grantee AC14 Authorization Form A voided check may be attached to this form. (CFDA Number) (Address of Financial Institution) Account Type: []Checking Savings Financial Institution Routing Number: - � Account Number: I These numbers are located on the bottom of your check as follows: 4. ;�?wlsra'I�lirttrtri�txuuylis�d'��n I hereby authorize the Indiana Housing and Community Development Authority (".U:.iC DA") to. — --- — 's initiate entries to checking/savings accounts at the lhiar�aial iristitutioii listed above, and, zirecessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect Until MCDA is notified by an authorized individual in writing to cancel it in such tirnc as to afford IIICDA and the financial institution a reasonable opportunity to act on it. In addition, I certify that I have full authority to execute this authorization and grant the rights to ITICDA contained herein. (Signature) (Date) ADDRESS 30 South Meridian Street, Suite 1000, Iridianapolis, IN 46204 PHONE 317 232 7777 TOLL FREE 800 872 0371 VVES www.ihrda.IN.gov SW1enFFndlana � � Lieutenant Governor 1 suzansie Crouch j EQUAL OPPORTUNITY EMPLOYER AND HOUSING AGENCY Federa9 Labor Standards Provisions Applicability The Project or Program to which the construction work covered by this contract pertains is being assisted by the United Stqtes of America and the following Federal Labor Standards Provisions are included in this Contract pursuant to the provisions applicable to such Federa# assistance. A. 1. (i) 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 payroil 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 casts reasonably anticipated for bona fide fringe benefits under Section I(b)(2) of the Davis -Bacon Act on behalf of laborers or mochanics 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 OF 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 an the wage determination for the c€assification 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)(LL) 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. (ii) (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 mot: U.S. Department of Housing and Urban Development Office of Labor Relations (9) 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- 014o,) (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)(ii)(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. (if!) 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-5 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 withheld 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. (i) 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 in Section I(b)(2)(B) of the Davis --bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5 (a)(1)(ly) that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in Section I(b)(2)(B) of the Davis - Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been 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 1216-0017.) (H) (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)(1) 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 fd 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 http,//www.dol.ciov/esa/whd/forms/wh347instr.litm 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 hot 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 1215-0149,) (b) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent Who pays or supervises the payment of the persons employed under the contract and shall certify the following: (1) That the payroll for the payroll period contains the information required to be provided under 29 CFR 5.5 (a)(3)(11), the appropriate information Is being maintained under 29 CFR 5.5(a)(3){i), and that such information is correct and complete; Previous editions are obsolete form HUD-4010 (06/2009) 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 properly executed certification set forth on the reverse side of Optional Form WH-34Y shall satisfy the requirement for submission of the "Statement of Compliance" required by subparagraph A. 3. (11)(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 1B and Section 231 of Title 31 of the United States Code. (tii) 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 falls 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, 4. Apprentices and Trainees. (l) Apprentices. Apprentices will be permitted to worts 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 shalt not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any 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 loss 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. (II) 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 apprentice wage rate, who Previous editions are obsolete a� form HUD-4010 (0612009) Page 3 of 6 ref. Handbook 1344.1 the Employment and Training Administration shall be paid not less than the applicable wage rate on the waga 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 be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. (M) 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. S. 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 meaning 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. (€) 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 he 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. (it) 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, (€€1) 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 requiremonts, 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 taborer 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 plause 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 ter(itory, 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 fn 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 (06I2009) 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 held 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 $100,000. (1) No laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous to his health and safety as determined under construction safety and health standards promulgated by the Secretary of Labor by regulation. (2) The Contractor shall comply with all regulations issued by the Secretary of Labor pursuant to Title 29 Part 1926 and failure to comply may result in imposition of sanctions pursuant to the Contract Work Hours and Safety Standards Act, (Public Law 91-54, 83 Stat 96). 40 USC 3701 et se-q- (3) The contractor shall include the provisions of this paragraph in every subcontract so (hat such provisions will be binding on each subcontractor. The contractor shall take such action with respect to any subcontractor as the Secretary of Housing and Urban Development or the Secretary of Labor shall direct as a means of enforcing such provisions. Previous editions are obsolete form HUD-4010 (06/2009) Page 5 of 5 ref. Handbook 1344.1 U.S. Department of Housing OMB Approval No. 2510-0011 (exp. 10131/2009) Applicant/Recipient and Urban Development DiSGIOSurelUpdate Report Inc frnr$inin z r.qPP Public Reoortincl Statement and. Privacy Act Statement and detailed instructions on page 2.) AmIlcant/Reci Name nt Information ame, Address, and Phone (include area code): State the name and location (street Indicate whether this is an Initial Report ❑ or an Update Report City and State) of the project or Social Security Number or Employer ID Number: 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 projector 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, Stopl You do not need to complete the remainder of this form. However, you must sign the certification at the end of the report. Part ll Other Government Assistance Prodded or Requested ! 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. peoarfinentlStatelLocal Agency Name and Address Type of Assistance Amount Expected Uses of the Funds n.,..:,v fF 4litrni,M—i (Note: Use Additional pages if necessary.) 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, br 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 list of all persons with a in the (Note: Use Additional pages if necessary.) de financial interest Social Security No.J Type of Participation in the last name first) or Em to ee ID No. I Pr9Ject/ActivitZ. ,st in and Certification rm, you may subject to civil or criminal penalties under Section 1001 of Title 18 of the Warning: If you knowingly make a false statement on this fo 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 certifv that this information is true and complete. Sig (mmlddlyyyy) 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 EINs 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 in no case fora 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 tart 15. HUD will use the information in evaluating individual assistance applications and in performing internal administrative analyses to assist in the management of specitir, 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 penaittes, 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 yod 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. B. Update reports (filed by "Recipients" of HUD Assistance): General. All recipients of covered assistance must submit update reports to the Department to reflect subsiantial changes to the initial applicant disclosure reports. Line -by -Line instructions. ApplicantlRecipient Information. All applicants for HUD competitive assistance, most complete the information required in blocks 1-5 of form HUD-2880: 1. Enier the full name, address, city, State, zip code, and telephone number (including area code) of the applicanilrecipient. Where the applicant/recipient is an individual, the last name, first name, and middle initial must be entered. 2. Entry of the applicantlrecipient'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 lime (such as project -based assistance under section 8 of the United States Housing Act of 1937), the amount of assistance to be reported lnctudes 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., REP No,; 1FB No.; grant announcement No,; or contract, grant, or loan No.) Include prefixes. Part 1, 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 Part. If the answer to eitherquestions 9 or 2 is No, the applicant need not complete Parts 11 and HI of the report, but must sign the certification at the end of the form. Fart 11. 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 fast 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 disclosuro 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 Ill. Interested Parties. This Part is to be completed by both applicants and recipients filing update reports. Applicants must provide informalion 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 projector activity for which the assistance is sought that exceeds $50,000 or 1 D percent of the assistance (whichever is lower). Note: A financial interest means any financial involvement in the project or aeitvity, including (but not limiled.to) situations in which an individual or entity has an equity interest to 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 foil 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 list all names alphabetically. 2. Entry of the Social Security Number (SSN) or Employee Identification Number (E1N), 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 persons 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 source/use 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 to Section 1.D.6., above. Motes: 1. Al 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 local 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-28130 (3199) Form w- (Rev. October 2007) Department of the Treasury Internal Revenue Service Request foir Taxpayer( Give form to the requester. Do not Identification Number and Certification I send to the IRS. Name (as shown on your income tax return) Business name, if different from above Check appropriate box: ❑ IndivlduatfSole proprietor ❑ corporation ❑ Partnership Exempt ❑ Limited liability company. Enter the tax classification (C=disregarded entity, G-corporation, P=partnorship) tY ------- ❑ payee ❑ (Mer (see instructions) Address (number, street, and apt. or suite no.) Requester's Hama and address (optional) City, state, and ZIP code List account number(s) here (optional) rer Identification Nutnber 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 I alien, sole proprietor, or disregarded entity, see the Part I instruct(ons on page 3. For other entities, it is or' your employer identification number (EIN). 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 mployer identification number number to enter. !'.nrFifira'1'inn 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 [ am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) 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 Here Signature of U.S. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. puir ]ose 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 form 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: a An individual who is a U.S. citizen or U.S. resident alien, a 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: s The U.S, owner of a disregarded entity and not the entity, Cat. No. 10231X Form W-9 (Rev. 10-20W) Form W-9 (Rev. 10-2007) o The U.S. grantor or other owner of a grantor trust and not the trust, and 0 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 continue 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 tax- purposes 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 certairi 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 aftor 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 $5f) 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. Ifyou 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. Spedit 8nstrueti®ns 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 (LLC). 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 LLC 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. Mote. 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 exeript 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(%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, 8. 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 .. _ THEN the payment is exempt for Interest and dividend payments Ali exempt payees except for 9 Broker transactions Exempt 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 $5,000 'See Form 1099-MiSC, Miscellaneous Income, and its instructions. zHowever, the following payments made to a corporation (Including gross proceeds paid to an attorney under section 6045(0, even if the attorney is a corporation) and reportable on Form 1099-MISO are not exempt from backup withholding: medical and health care payments, attorneys' fees, and payments for services paid by a federal executive agency. 3 Part i. Taxpayer Identification Number (TIM) 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 )s your IRS individual taxpayer identification number (]TIN). 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 FIN, you may enter either your SSN or FIN. However, the IRS prefers that you use your SSN. If you are a single -member LLG that Is disregarded as an entity separate from its owner (see Limited liability company (LLC) on page 2), enter the owner's SSN (or FIN, if the owner has one). Do not enter the disregarded entity's FIN. 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 off lco 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 ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an FIN. You can apply for an EIN online by accessing the IRS website at www.1rs.gov/businesses and clicking on Employer identification Number (E1N) under Starting a Business. You can gat 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. Gautiom A disregarded domestic entity that has a foreign owner must use the appropriate Form W 8. Para li. 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 I 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. Form W-9 (Rev. 14-2007) 3. heal 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 Cure the Requester For this type of aeeOunt: 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 revocable 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 6. Sole proprietorship or disregarded The owner' entity owned by an individual For this type of account: Give name and E1N of: 6. Disregarded entity not owned by an The owner individual 7. A valid trust; estate, or pension trust Legal entity' 8. 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 'fist first and circle the name of rho person whose number you furnish. If only one person on a joint account has an SSN, that person's number must be furnished. 2Circle the minor's name and turnlsh the minor's SSN. sYou must show your individual name and you may also enter your business or " PBA" name on the second name line. You may use either your SSN or FIN (if you have one), but the IRS encourages you to use your SSN. " fist first and circle the name of the trust, estate, or pensfon trust. Po not furnish the TIN of the personal represenlailve or trustee unless the legal entity itself Is not designated in the account title.) Also see Speciaf rules for partnerships 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 identity 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 a Protect your SSN, o 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 -877-777-477 B orTTY/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 emails 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: spam@uce.gov or contact them at www.consumer.gov/idtheft or 1-877-IDTHEFT(438-4336). 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 10 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 noniax criminal laws, or to federal law enforcement and Intelligence agencies to combat terrorism. You must provide your TIN whether or not you ale required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other payments to a payea who does not give a TIN to a payer. Certain penalties may also apply. I> dAana Housing and Community Deve opment Autho rnty CDBG Payroll Authorization Form - Recipient Recipient: City of South Bend ,Opard Number: I)R2OR-01.8-003 Please list all employees and their respective rate of pay that will be utilized on this award. Tf 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. 1. 2. 3. 4. 5. 6. 7. 8. 9, 10. Seal: Em to ee Name Primary Authorized Signature Signature .Typed Name and Title Date Notary Public Subscribed and sworn before the this of 20— Notary Public Typed Name day My Commission Expires Comity of Residence Hourly Rate o Pav $ $ Hourly Fine Bene t or 1'ercenta�e INDIANA HOUSING AND COMMUNITY DEVELOPMENT AUTHORITY STATE OF INDIANA DRUG-FRFIX WORIaLAOE 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 part 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-fi-ee 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) tape 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. THE UNDERSIGNED AFFIRMS, UNDEiR PENALTIES OF PERJURE', TIIAT ITE OR SHE IS AUTHORIZED TO EXECUTE THIS CERTIFICATION ON BEHALF OF THE DESIGNATED' ORGANI7 WON. Ci of South Bend Printed Name of Organization Signature ofAthorizedRePresentative Printed Narne and Title DR20R-018-003 Reqursition/Coniract/Grant ID Number Date STATE FORM 44260 (R/4-91) INDIANA_ HOUSING & COMMUNITY DEVELOPMENT AUTHORITY COMMUNITY I)EVELOPMENi' BLOCK GRANT - DISASTER RELIEF 11 RESOLUTIONS OF City of South Bend The undersigned, as Secretary of City of South Read (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 inajority 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 Community Development Block Grant Program — Disaster Relief II, administered by hadiana Housing and Community Development Authority ("IHCDA") in an amount not to exceed One Hundred Forty Three Thousand Nine Hundred Six dollars 00/100 ($143, 906.00) according to the terms and conditions as more particularly described 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, aelmowledge 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. DR20R-0I s-a03 CITY of SOTJTH BEND PAcE I OF 4 RESOLUTIONS INDIANA HOUSING & COMM-UNITY OE' VELOI'MENT AUTHORITY COMM-UNITY DEVELOPMENT BLOCK CIRAIONT DISASTER ]RELIEF II RESOIXTIONS OF City of South Bend ATTEST; The above resolutions are true and accurate copies of the resolutions approved an as reflected in the Board's minutes entered in its corporate records. Date: Secretary, City of South Bend Print Name 1472412 1; BME; 08/21/09 DR20R 018-003 CITY OF SOUTH BEND Nor 2 or 4 RESOLUTIONS INDIANA HOUSING & COMMUNITY YDEVELOPMENT AUTHORITY COMMUNITY DEVEI_,OPMENT BLOCK GRANT - DISASTER RELlElf TI RESOLUTIONS OF city of South Bend DR20R-019-003 CITY OP' S OUTH BEND PAGE 3 OF 4 RESOLUTIONS II@ DIANA HOUSING & COMMUNITY DE, VELOPMENT AIUTHOFJTY COIV MUNIT'Y PE�TELOPMENT BLOCK GRANT - DISASTER RELIEF II RESOLUTIONS OF City of South Bend DR20R 018-003 CITY of so iT H BEND PAaB 4 of 4 RESOLUTIONS INDIANA HOUSING & COMMUNITY DEVE LOPMEIa T AUTHORITY COMMUNITY DEVELOPMENT BLOCK GRANT - DISASTER RELIEF It OF City of South Bend The undersigned, being all of the Directors/Members of _ organized and existing udder 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 Community Development Block Grant Program from the Community Development Block Grant Program — Disaster Relief 1I, administered by Indiana Housing and Community Development Authority ("IHCDA"), in an amount not to exceed One hundred Forty Three Thousand Nine Hundred Six dollars and 0/100 ($143, 906.00) according to the terms and conditions as are more particularly set forth in the 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: Naine 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, in a form and manner as is acceptable to IHCDA APPROVED AND ADOPTED, this day of ) 20 By: By: Name: Name: — Title: Title: By: By: Name: Name: CITY OFSOUTH BEND DR20R-018-003 PAcr, 1 or 2 RFSOLUTIONS INTDIANA 1E10USINC & COMMUNITY (DEVELOPMENT AUTHORITY COMMUNITY J[DEV L®PMENT BLOCK GRANT - (DISASTER RE, LIEF II OF City of South Bend Title: Title: By: By: Nagle: Name: Title: Title: By: By: Name: Name: Title: Title: By: By: Name: Name: Title: Title: By: By: Name: Name: Title: Title: By: By: Name: Name: Title: ........ Title: 0 1472409 1; BMF: 08/21/09 ZY OF SOUTH BLND DR2O1t-018-003 OTFoxs paGa 2 or 2 0 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date September 18, 2018 Name Pain Mever Department DCI BPW Date September 25, 2018 Phone Extension 5845 Legal M Attorney Name Sandra Kennedy Controller El Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing n N Agreement F] Professional Services Bid Opening Quote Opening F-1 Change Order No. R Ease/Encroach. F-1 Other: Company or Vendor Name S Contract F1 ResoIution Bid Award Quote Award & PCA No. El Traffic Control 9 =4 El Req. to Advertise IMEN F.15 1114 =1 I I F1 Title Sheet Indiana Housing and Community Development Authority (IFICDA) New Vendor 0 Yes Z No El If Yes, Approved by Purchasing MBEANBE Contractor F] MBE n WBE Project Name Supplemental Disaster Recovery -Owner Occupied Rehab, for Lead Project Number Funding Source CDBG Disaster Recovery Federal Funding through IHCDA Account No. Amount $__143,906.00 Terms of Contract 8/31/18-12/31/18 Purpose/Description To administer a program to identify and control lead - based paint hazards in eligible privately owned owner occupied housing units. El Required Contractor's Certification Form Attached (Non - Collusion. Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) Amount of F1 increase $ El Decrease $ Previous Amount $ Current Percent of Change: New Amount $ Total Percent of Change: Copy Original M M Pam F-1 ❑ El El Dispersal After Approval , I)CI