HomeMy WebLinkAboutS4- Parks, Recreation & Community Services CITY OF SAN BERNARDINO REQUEST FOR COUNCIL ACTION
RESOLUTION OF THE CITY OF SAN BERNARDINO
From: ANNIE F. RAMOS, DIRECTOR Subject: AUTHORIZING THE DIRECTOR OF PARKS, RECREA-
TION AND COMMUNITY SERVICES DEPARTMENT
Dept: PRKS, RECREATION AND COMMUNITY SERVICES TO EXECUTE A CONTRACT WITH THE COUNTY OF
SAN BERNARDINO TO PROVIDE THE YOUTH
Date: AUGUST 21, 1996 MENTORING PROGRAM.
f D
U U _ U
Synopsis of Previous Council action:
November 21, 1994 - Council approved position of Mentor Coordinator and directed
staff to find funding.
December 5, 1994 - Council authorized transfer of funds to pay for Mentoring
Program.
April 17, 1995 - Council adopts resolution contracting Mentor Coordinator.
April 1, 1996 - Council amends agreement extending contract.
AUG 26`96 PM 4:05
Recommended motion:
Adopt Resolution
tt ' -
Signature
Contact person: John A. Kramer Phone: 384-5031
Supporting data attached: Staff Report, Reso & Agreement Ward: City - Wide
FUNDING REQUIREMENTS: Amount:
Source: (Acct. No.)
(Acct. Description)
Finance:
;ouncil Notes:
Continued to
'5-0262 Agenda Item No.
CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION
STAFF REPORT
RESOLUTION OF THE CITY OF SAN BERNARDINO
AUTHORIZING THE DIRECTOR OF PARKS, RECREATION
AND COMMUNITY SERVICES DEPARTMENT TO EXECUTE
A CONTRACT WITH THE COUNTY OF SAN BERNARDINO
TO PROVIDE THE YOUTH MENTORING PROGRAM.
The Mentoring Program was established in April of 1995 as a project of the
Mayor' s Youth Task Force. The initial funding came from the City and the
San Bernardino City Unified School District as a partnership to provide both
mentoring and the Late Night Hoops Program.
The Youth Task Force submitted a proposal for C.D.B.G. funding to the County of
San Bernardino in order to continue the Mentoring Program. The funding in the
amount of $19,500 will cover six additional months of the program. The Youth
Task Force has submitted a proposal for City C.D.B.G. supplemental funding to
cover the subsequent six months.
Entering its second year, the Mentoring Program has had great success. Mentors
have been established at every middle school in the district and current recruit-
ments are expected to double the number of mentors from 40 to 80 this year.
Justification for Supplemental Agenda
The contract covers the six month period of September 1, 1996 through February
28, 1997.
JAK:u
8/26/96
-s•ozea
1 RESOLUTION NO .
2 RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE DIRECTOR
OF PARKS, RECREATION AND COMMUNITY SERVICES DEPARTMENT TO EXECUTE A
3 CONTRACT WITH COUNTY OF SAN BERNARDINO TO PROVIDE THE YOUTH MENTORING
PROGRAM.
4
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
5 BERNARDINO AS FOLLOWS:
6 SECTION 1. The Director of Parks, Recreation and Community Services
7 Department of the City of San Bernardino is hereby authorized and directed
8 to execute a. contract with the County of San Bernardino to provide the Youth
9 Mentoring Program. A copy of said contract is attached hereto, marked
10 Exhibit "A" and incorporated herein by reference as fully as though set
11 forth at length.
12 SECTION 2. The authorization granted hereunder shall expire and be
13 void and of no further effect if the agreement is not executed by both
14 parties and returned to the Office of the City Clerk within sixty (60) days
15 following the effective date of the resolution.
16 I HEREBY CERTIFY that the foregoing resolution was duly adopted by
17 the Mayor and Common Council of the City of San Bernardino at a
18 meeting thereof, held on the day of ,
19 1996, by the following vote to wit:
20 COUNCIL MEMBER AYES NAYS ABSTAIN ABSENT
21 NEGRETE
22 CURLIN
23 ARIAS
24 OBERHELMAN
25 DEVLIN
26 ANDERSON
27 MILLER
28
CITY CLERK
8/26/96
-1- Sy
1 RE: RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE DIRECTOR
OF PARKS, RECREATION AND COMMUNITY SERVICES DEPARTMENT TO EXECUTE A
2 CONTRACT WITH COUNTY OF SAN BERNARDINO TO PROVIDE THE YOUTH MENTORING
PROGRAM.
3
The foregoing resolution is hereby approved this
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day of 1996.
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8 Tom Minor, Mayor
City of San Bernardino
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Approved as to form
10 and legal content:
11 James Penman
City Attorney
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By:
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CONTRACT
This Contract is made and entered into this day of
19 , by and between the County of San Bernardino,hereinafter referred to as "COUNTY", and the City of San
Bernardino Mayor's Task Force/Youth Mentoring Program, a public non-profit organization, hereinafter referred to
as "MENTORING PROGRAM".
WITNESSETH
WHEREAS,COUNTY has entered into a contract with the United States of America through its Department
of Housing and Urban Development, hereinafter referred to as "HUD", to execute the COUNTY Community
Development Block Grant (CDBG) Program under the Housing and Community Development Act of 1974, as
amended, hereinafter referred to as the "ACT"; and,
WHEREAS, COUNTY Department of Economic and Community Development hereinafter referred to as
"ECD", is authorized to act on behalf of COUNTY in administering the COUNTY CDBG program; and,
WHEREAS, MENTORING PROGRAM desires to participate in the COUNTY CDBG program and is
qualified by reason of experience,preparation,organization,staffing,and facilities to provide at-risk youth mentoring
and related support services; and,
WHEREAS,COUNTY recognizes the public benefit in providing such a program to low-and moderate-income
persons.
NOW THEREFORE, in consideration of the mutual covenants herein set forth and the mutual benefits to be
derived therefrom, the parties agree as follows:
1. SCOPE OF SERVICES
The MENTORING PROGRAM will establish a mentoring and support program for at-risk youth from seven
(7) middle schools(see attached list)within the unincorporated areas of the Fifth Supervisorial District and
the City of San Bernardino. This program will establish a Mentoring Advisory Board to include
representatives from the business community, local schools, civic leaders, churches, service clubs and local
colleges. The MENTORING PROGRAM will establish program partnerships between the Unified School
District and volunteer members from the local community to mentor at-risk youth. The program's primary
goals are to assist the at-risk youth from the targeted schools in improving their academic skills, and help the
community by reducing the drop-out rate,preventing teen pregnancy,reducing juvenile delinquency,curtailing
the use of illegal drugs and decreasing the gang involvement rate. A full description of the services provided
under the terms of this contract is outlined in Exhibit 1 of 7; PROJECT/ACTIVITY DESCRIPTION.
At least 51% of the beneficiaries of the at-risk youth in the mentoring program shall be from low-and
moderate-income households. Approximately 4,775 students (72%) from the 7 middle schools' total
population of 7,700 students have been identified as being eligible, based on their previous ability to meet
the requirements and qualify for the federally subsidized, "Free or Reduced Cost Lunch Program".
Unless specified otherwise, ECD shall have the authority to represent COUNTY regarding the terms and
conditions of this Contract and the administration thereof.
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2. TIME OF PERFORMANCE
Said services of MENTORING PROGRAM are to commence September 1, 1996 and shall be completed no
later than February 28, 1997.
3. COMPENSATION AND METHOD OF PAYMENT
For performance of such services,COUNTY shall provide CDBG funds not to exceed nineteen thousand five
hundred dollars($ 19,500). This payment shall constitute full and complete compensation for MENTORING
PROGRAM services under this Contract. For the purpose of this Contract, COUNTY shall disburse
compensation and monitor MENTORING PROGRAM performance in satisfying the scope of work
obligations under the terms of this Contract.
Disbursement of payments to MENTORING PROGRAM shall be made by monthly reimbursements,
contingent upon COUNTY receipt of a monthly summary statement for each previous months' expenditures
which conforms to the BUDGET SUMMARY, attached hereto as Contract Exhibit 2 of 7. Monthly
expenditure reports shall be documented with "Audit Ready" supportive evidence of each expenditure and
proof of payment, in accordance with HUD regulations. The monthly expenditure report submitted by
MENTORING PROGRAM must list the "Other Sources"that are co-funding budget line items as stated in
Exhibit 3 of 7,BUDGET JUSTIFICATION-PART I,(Supplies/Services). Reimbursements shall be limited
to the total of approved properly documented expenditures. Each monthly reimbursement shall be evenly
amortized over the remaining term of this contract unless otherwise approved by ECD. All requests for
reimbursement must be submitted no later than 60 days after the expiration of this Contract.
MENTORING PROGRAM must submit said monthly expenditure reports by the 10th calendar day of every
calendar month regardless of expenditure amount. After receipt by COUNTY of each properly documented
expenditure,COUNTY will draw a warrant in favor of MENTORING PROGRAM for approved expenditure
amount. Expenditure reports received after the tenth(10th)calendar day of the month in which payment is
requested will cause unavoidable delays in payment processing.
4. BUDGET SECTION
No more than the amounts specified in the BUDGET SUMMARY, attached hereto as Contract Exhibit 2 of
7,may be spent for the separate cost categories specified in the BUDGET SUMMARY without prior written
approval of COUNTY. Contract Exhibit 3 of 7,BUDGET JUSTIFICATION-PART 1,(Supplies/Services),
explains the basis of valuation for each cost category shown on the BUDGET SUMMARY.
5. USE OF FUNDS
Funds allocated pursuant to this Contract shall be used exclusively for costs included in MENTORING
PROGRAM budget. Contract funds shall not be used as security or to guarantee payments for any non
program obligations, nor as loans for non-program activities.
6. BUDGET MODIFICATIONS
ECD Director or his designee may grant budget modifications to this Contract for the movement of funds
within the budget categories identified in Contract Exhibit 2 of 7, BUDGET SUMMARY, when such
modifications:
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a. Do not exceed $10,000 per budget cost category;
b. Are specifically requested by MENTORING PROGRAM;
C. Do not alter the amount of compensation with this Contract;
d. Will not change the project goals or scope of services;
e. Are in the best interests of COUNTY and MENTORING PROGRAM in performing the scope
of services under this Contract; and
f. Related to salaries, are in accordance with applicable salary ordinances or laws.
7. CHANGES IN GRANT ALLOCATION
COUNTY reserves the right to reduce the grant allocation when COUNTY fiscal monitoring indicates that
MENTORING PROGRAM rate of expenditure will result in unspent funds at the end of the program year.
Changes in the grant allocation will be done after consultation with MENTORING PROGRAM. Such changes
shall be incorporated into this Contract by written amendments.
8. REVENUE DISCLOSURE REQUIREMENT
By its execution of this Contract,MENTORING PROGRAM certifies that it has previously filed with ECD,
a written statement listing all revenue received, or expected to be received, by MENTORING PROGRAM
from federal, state, city or COUNTY sources, or other governmental or private agencies, and applied or
expected to offset in whole or in part any of the costs incurred by MENTORING PROGRAM in conducting
current or prospective projects or business activities, including, but not necessarily limited to, the project or
business activity which is the subject of this Contract. Such statement shall reflect the name and a description
of such project or business activity,the dollar amount of funding provided, or to be provided, by each and
every agency to each such project or business activity, and the full name and address of each such agency.
During the term of this Contract,MENTORING PROGRAM shall prepare and file a similar written statement
each time it receives funding from any agency which is in addition to that revenue disclosed in MENTORING
PROGRAM initial revenue disclosure statement hereunder. Such statement shall be filed with ECD within
fifteen (15) calendar days following receipt of such additional funding. MENTORING PROGRAM shall
make available for inspection and audit to COUNTY representatives, upon request, at any time during the
duration of this Contract and during a period of three(3)years thereafter, all of its books and records relating
to the operation by it of each project or business activity which is funded in whole or in part with governmental
monies, whether or not such monies are received through COUNTY. All such books and records shall be
maintained by MENTORING PROGRAM at a location in San Bernardino County. Failure of MENTORING
PROGRAM to comply with the requirements of this section of the Contract shall constitute a material breach
of contract upon which COUNTY may cancel, terminate,or suspend this Contract.
9. JOINT FUNDING
For programs in which there are sources of funds in addition to CDBG funds,MENTORING PROGRAM shall
provide proof of such funding. COUNTY shall not pay for any services provided by NIENTORING
PROGRAM which are funded by other sources. All restrictions and/or requirements provided in this Contract
relative to accounting, budgeting, and reporting apply to the total program regardless of funding sources.
10. PROGRAM iNCONIE
Program income represents net income directly generated from the use of CDBG funds by MENTORING
PROGRAM as a result of the activity funded under the terms of this Contract. When such income is generated
by an activity only partially assisted with CDBG funds,the income shall be prorated to reflect the percentage
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of CDBG funds used. MENTORING PROGRAM shall retain the use of program income by returning
program income to COUNTY and requesting project budget increases for activities authorized under this
Contract. Program income shall be returned to COUNTY within thirty(30) days after: a) disposition or sale
of real or personal property occurs or; b) cumulative program income reaches increments of one thousand
dollars ($1,000); or c) the end of each fiscal year. MENTORING PROGRAM shall include in the reports
required by Paragraph 21, Program Reporting,all sources and amounts of program income on a monthly and
year-to-date basis.
Program income returned by COUNTY to MENTORING PROGRAM shall be spent by MENTORING
PROGRAM on only those costs authorized under this Contract. All provisions of this Contract shall apply
to said use of program income funds. MENTORING PROGRAM shall account for the receipt and use of
program income in such a way that program income is spent on authorized activities before additional CDBG
funds are spent.
Any program income on-hand when this Contract expires or is received after such expiration, shall be paid
to COUNTY.
11. FISCAL LIMITATIONS
The United States of America through HUD may in the future place programmatic or fiscal limitation(s)on
CDBG funds not presently anticipated. Accordingly, COUNTY reserves the right to revise this Contract in
order to take account of actions affecting HUD program funding. In the event of funding reduction,COUNTY
may reduce the budget of this Contract as a whole or as to cost category, may limit the rate of MENTORING
PROGRAM authority to commit and spend funds,or may restrict MENTORING PROGRAM use of both its
uncommitted and its unspent funds. Where HUD has directed or requested COUNTY to implement a
reduction in funding, in whole or as to cost category, with respect to funding for this Contract, ECD may act
for COUNTY in implementing and effecting such a reduction and in revising the Contract for such purpose.
Where COUNTY had reasonable grounds to question the fiscal accountability, financial soundness, or
compliance with this Contract of MENTORING PROGRAM,COUNTY may act to suspend the operation of
this Contract for up to sixty(60)days upon three(3)days notice to MENTORING PROGRAM of its intention
to so act,pending an audit or other resolution of such questions. In no event,however,shall any revision made
by COUNTY affect expenditures and legally binding commitments made by MENTORING PROGRAM
before it received notice of such revision,provided that such amounts have been committed in good faith and
are otherwise allowable and that such commitments are consistent with HUD cash withdrawal guidelines.
12. NONEXPENDABLE PROPERTY
A record shall be maintained for each item of nonexpendable property acquired for this program with CDBG
funds. This record shall be provided to COUNTY upon request. Nonexpendable property shall include
tangible personal property, including but not limited to office equipment, and real property and any interest
in such real property, including any mortgage or other encumbrance of real property as well as any funds
derived from the sale or disposal of nonexpendable property. Any utilization of funds derived from the sale
or disposition of nonexpendable property must have prior approval of COUNTY and otherwise comply with
all applicable laws and regulations. Upon termination of this Contract, COUNTY reserves the right to
determine the final disposition of said nonexpendable property acquired for this program with CDBG funds,
including funds derived therefrom. Said disposition may include COUNTY taking possession and title of said
nonexpendable property. Nonexpendable personal property means tangible personal property having a useful
life of more than one(1) year and an acquisition cost of$500 or more per unit.
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13. EXPENDABLE PERSONAL PROPERTY
Expendable personal property refers to all tangible personal property other than nonexpendable personal
property. All purchased expendable personal property with a unit value of$500 or more per unit must have
the prior written approval of the ECD Director, or his designee.
14. PURCHASE OR LEASE OF NONEXPENDABLE PROPERTY OREQUIPMENT
Upon approval by COUNTY, MENTORING PROGRAM shall obtain three documented bids prior to
purchasing or leasing any nonexpendable personal property or equipment over$500 in unit value and having
a life expectancy of more than one(1)year. Such property shall be properly identified and inventoried and
shall be charged at its actual price deducting all cash discounts, rebates, and allowances received by
MENTORING PROGRAM. This inventory shall be provided to COUNTY upon request.
15. ACQUISITION OF SUPPLIES AND EQUIPMENT
MENTORfNG PROGRAM may purchase from a related agency/organization only if: (a)prior authorization
is obtained in writing from COUNTY,(b)charges do not exceed the authorized amount and minimum written
specifications are met, (c) a community related benefit is derived from such MENTORING PROGRAM
related acquisition, and (d) no conflict of interest for private gain accrues to MENTORING PROGRAM or
its employees, agents or officers.
COUNTY reserves the right to disallow any purchase from any vendor of supplies,equipment,nonexpendable
property or expendable property which is purchased in whole or in part with funds provided by this Contract.
MENTORNG PROGRAM may seek prior approval of COUNTY for any such expenditures, and prior
approval which is granted shall be binding on COUNTY unless such expenditure violates federal law or
regulations or is disallowed by HUD.
16. PURCHASE AND INVOICE DEADLINES
Purchase of equipment or property must be completed before the last three (3) months of the initial
performance period and all equipment bills are to be paid before the last two(2) months of this period. No
expendable or nonexpendable property or equipment is to be purchased during the final three(3)months of
the initial performance period unless approved by COUNTY in writing. Invoices for all obligations incurred
under this Contract must be submitted to ECD Fiscal Division within sixty (60) days after the initial
performance period termination date or they may not be honored. Exceptions to the preceding limitations
require prior written approval by ECD.
17. TRAVEL AND CONFERENCE RESTRICTIONS
MENTORING PROGRAM certifies and agrees that travel and conference expenses for persons other than
employees of MENTORNG PROGRAM,will not be paid by funds provided through this Contract. No travel
expenses for out-of-state travel shall be included in this Contract unless specifically listed in the BUDGET
SUMMARY, Contract Exhibit 2 of 7,which is attached and incorporated herein. MENTORNG PROGRAM
further agrees that any travel expense incurred by MENTORING PROGRAM which is not listed in the Budget
Summary shall not be paid by funds provided through this Contract unless prior written approval of ECD
Director has been obtained.
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18. USE OF FUNDS FOR ENTERTAINMENT GIFTS OR FUND RAISING ACTIVITIES
%1ENTORNG PROGRA:N1 certifies and agrees that it will not use funds provided through this Contract to pay
for entertainment, gifts, or fund raising activities.
19. MONITORING
ECD Director or his designee will conduct periodic program monitoring reviews. These reviews will focus
on the extent to which the planned program has been implemented and measurable goals achieved,
effectiveness of program management, and impact of the program. Authorized representatives of COUNTY
and HUD shall have the right of access to all activities and facilities operated by MENTORING PROGRAM
under this Contract. Facilities include all files, records, and other documents related to the performance of
this Contract. Activities include attendance at staff,board of directors,advisory committee and advisory board
meetings and observation of on-going program functions. MENTORING PROGRAM will permit on-site
inspection by COUNTY,and HUD representatives,and ensure that its employees and board members furnish
such information,as in the judgement of COUNTY and HUD representatives, may be relevant to the question
of compliance with contractual conditions and HUD directives,or the effectiveness,legality,and achievements
of the program.
20. BENEFICIARY QUALIFICATION
Persons qualifying for program services on the basis of income, hereinafter referred to as BENEFICIARIES,
shall have an annual household gross income equal to or less than the U.S.Department of Housing and Urban
Development(HUD) Section 8 (of the United States Housing Act of 1937)Income Limits. HUD Section 8
Income Limits for the Riverside-San Bernardino RMSA,define the maximum annual household gross income
for low-and moderate-income households. MENTORING PROGRAM is responsible for obtaining from
COUNTY the said current applicable HUD Section 8 Income Limits for each year of the Contract term
identified in Paragraph 2,Time of Performance. Under CDBG regulations,the following clientele categories
are presumed to be low-and moderate-income persons and can qualify for service regardless of income:
Abused Children; Battered Spouses;Elderly Persons(60 and older); Handicapped Persons;Homeless Persons;
Illiterate Persons; Migrant Farm Workers. MENTORING PROGRAM shall document the household income
of all BENEFICIARIES, by obtaining completed copies of the 'BENEFICIARY QUALIFICATION
STATEMENT", Exhibit 5 of 7. MENTORING PROGRAM shall retain these forms for three years(3)after
conclusion of this Contract.
21. PROGRAM REPORTING
INIENTORNG PROGRAM agrees to prepare and submit financial, program progress, evaluations, and other
reports as required by HUD or COUNTY directives. MENTORING PROGRAM shall maintain such property,
personnel, financial and other records and accounts as are considered necessary by HUD or COUNTY to
assure proper accounting for all Contract funds. All MENTORING PROGRAM records, with the exception
of confidential client information,shall be made available to representatives of COUNTY and the appropriate
federal agencies. '114ENTORING PROGRAM is required to submit data necessary to complete the Annual
Grantee Performance Report in accordance with HUD regulations in the format and at the time designated by
COUNTY Director of ECD or his designee. By the tenth(10th) of each month, MENTORING PROGRAM
shall submit a completed PROGRAM PROGRESS REPORT, Exhibit 6 of 7, for the month being reported.
MENTORING PROGRAM shall also provide the MONTHLY DIRECT BENEFIT information included on
this exhibit, as necessary for completion of the Annual Grantee Performance Report.
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22. ACCOUNTING
iV1ENTORNG PROGRAM must establish and maintain on a current basis an adequate accounting system in
accordance with HUD directives and generally accepted accounting principles.
23. AUDITS
iVIENTORING PROGRAM is required to arrange for an independent financial/compliance audit performed
within the direction of Generally Accepted Auditing Standards and Government Auditing Standards. Said
audit shall be conducted for the term of this contract. When MENTORING PROGRAM receives $25,000 or
more in federal funds from all funding sources within a fiscal year, the required audit must be performed in
compliance with OMB Circular A-133.
MENTORING PROGRAM shall submit a copy of the audit report to COUNTY within thirty (30) days of
completion. Within thirty(30)days of the submittal of said audit report,MENTORING PROGRAM shall
provide to COUNTY a written response to any concerns or findings identified in said audit report. The
response must examine each concern or finding and explain a proposed resolution, including a schedule for
correcting any deficiency. All actions to correct said conditions or findings shall be taken within six (6)
months after receipt of the audit report.
COUNTY,or any state or federal agency, may make additional audits or reviews, as necessary,to carry out
the responsibilities of MENTORING PROGRAM under COUNTY, state or federal laws and regulations.
MENTORING PROGRAM agrees to cooperate fully with all persons conducting said additional audits or
reviews. COUNTY and its authorized representatives shall, at all times, have access for the purpose of audit
or inspection, to any and all books, documents, papers, records, property, and premises of MENTORING
PROGRAM.
If indications of misappropriation or misapplication of the funds of this Contract cause COUNTY to require
an additional audit,the cost of the audit will be encumbered and deducted from this Contract budget. Should
COUNTY subsequently determine that the additional audit was not warranted, the amount encumbered will
be restored to the Contract budget. MENTORING PROGRAM shall reimburse all misappropriation or
misapplication of funds to COUNTY. In the event COUNTY uses the judicial system to recover
misappropriated or misapplied funds, MENTORING PROGRAM shall reimburse COUNTY legal fees and
court costs in addition to awards.
24. ASSIGNMENT
This Contract is not assignable by MENTORING PROGRAM without the express written consent of
COUNTY. Any attempt by MENTORING PROGRAM to assign any performance of the terms of this
Contract shall be null and void and shall constitute a material breach of this Contract.
25. TERMNATION AND TERMINATION COSTS
This Contract may be terminated in whole or in part at any time by either party upon giving their(30) days
notice in writing to the other parry. Agreement must be reached by both parties as to reasons and conditions
for termination in compliance with the provisions of federal regulations at 24 CFR Part 84.6 1, Termination
for Convenience. ECD is hereby empowered to give said notice subject to ratification by the COUNTY Board
of Supervisors.
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COUNTY may immediately terminate this Contract upon the termination, suspension, discontinuation or
substantial reduction in CDBG funding for the Contract activity or if for any reason the timely completion of
the work under this Contract is rendered improbable, infeasible or impossible. If MENTORING PROGRAM
materially fails to comply with any term of this Contract, COUNTY may take one or more of the actions
provided under federal regulation at 24 CFR Part 84.62,Enforcement,which include temporarily withholding
cash, disallowing non-compliant costs, wholly or partly suspending or terminating the award, withholding
further awards,and other remedies that are legally available. In such event,MENTORING PROGRAM shall
be compensated for all services rendered and all necessarily incurred costs performed in good faith in
accordance with the terms of this Contract that have been previously reimbursed, to the date of said
termination to the extent that CDBG funds are available from HUD.
26. REVERSION OF ASSETS
Upon Contract termination MENTORING PROGRAM shall transfer to COUNTY all CDBG funds on-hand
at the time of expiration and any accounts receivable attributable to the use of CDBG funds.
All real property acquired or improved in whole or in part with CDBG funds under this Contract must continue
in the use that provides the service benefits and national objectives for which it was funded, or it must be
disposed of in a manner resulting in a reimbursement to COUNTY in the amount of the current fair market
value of the property less any portion thereof attributable to expenditures of non-CDBG funds for the
acquisition of, or improvement to,the property.
27. TIME OF PERFORMANCE MODIFICATIONS
ECD Director may grant time of performance modifications to this Contract when such modifications:
a. In aggregate do not exceed twelve (12)calendar months;
b. Are specifically requested by MENTORING PROGRAM;
C. Will not change the project goals or scope of services;
d. Are in the best interests of COUNTY and MENTORING PROGRAM in performing the scope
of services under this Contract; and
e. Do not alter the amount of compensation under this Contract.
28. INDEPENDENT CONTRACTOR
All parties hereto in the performance of this Contract will be acting in an independent capacity and not as
agents, employees, partners,joint venturers, or associates of one another. The employees or agents of one
party shall not be deemed or construed to be the agent or employees of the other party for any purpose
whatsoever.
29. AFFIRMATIVE ACTION AND CONTRACT COMPLIANCE
MENTORING PROGRAM shall make every effort to ensure that all projects funded wholly or in part by
CDBG funds shall provide equal employment and career advancement opportunities for minorities and
women. In addition, MENTORNG PROGRAM shall make every effort to employ residents of the area and
shall keep a record of the positions that have been created directly or as a result of this program.
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COUNTY has a goal of 15 percent Minority Business Enterprise (MBE), 5 percent Women Business
Enterprise (WBE), and 3 percent Disabled Veteran Business Enterprise(DVBE)participation in all contracts.
INIENTORING PROGRAM agrees to comply with the provisions of the Affirmative Action Compliance
Program of COUNTY and rules and regulations adopted pursuant thereto. MENTORING PROGRAM shall
comply with Executive Orders 11246, 11375, 11625, 12138, 12432, 12250, Title VII of the Civil Rights Act
of 1964, the California Fair Housing and Employment Act, California Public Contracts Code 2000 and
COUNTY T'vI/WBE/DVBE Policy No. 11-15, as revised, and other applicable federal, state and COUNTY
laws, regulations and policies relating to equal employment and contracting opportunities, including laws and
regulations hereafter enacted.
30. DISCRIMINATION
No person shall, on the grounds of race, sex, creed, color, religion, or national origin, be excluded from
participating in, be refused the benefits of, or otherwise be subjected to discrimination in any activities,
programs, or employment supported by this Contract.
31. RELIGIOUS PROSELYTIZING OR POLITICAL ACTIVITIES
MENTORING PROGRAM agrees that it will not perform or permit any religious proselytizing or political
activities in connection with the performance of this Contract. Funds under this Contract will be used
exclusively for performance of the work required under this Contract and no funds made available under this
Contract shall be used to promote any religious or political activities.
32. CONFLICT OF INTEREST
MENTORING PROGRAM, its agents and employees shall comply with all applicable federal, state and
COUNTY laws and regulations governing conflict of interest. To this end, MENTORING PROGRAM will
make available to its agents and employees copies of all applicable federal, state, and COUNTY laws and
regulations governing conflict of interest. In particular,the following federal regulation paraphrased from 24
CFR 570-611, Conflict of Interest: Except for salaries and related administrative or personnel costs, no
employees, agents consultants, officers or elected officials or appointed officials, of subrecipients which
receive CDBG funds, who exercise or have exercised any CDBG functions or who are in a position to
participate in a decision making process or gain inside information,may obtain a personal or financial interest
or benefit from a CDBG assisted activity or any CDBG funded contract,subcontract or agreement,during their
tenure or for one year thereafter.
MENTORING PROGRAM shall furnish to COUNTY,prior to execution of this Contract, a written list of all
current or proposed subgrantees/subcontractors,vendors or personal service providers, including subsidiaries
of LENTORING PROGRAM. This list should be limited to those subgrantees/subcontractors, vendors or
personal service providers, including subsidiaries of MENTORING PROGRAM, which will receive $10,000
or more during the term of this Contract. Such a list shall include the names, addresses, telephone numbers,
and identification of principal party(ies), and a description of services to be provided. During the term of this
Contract,'i'vIENTORING PROGRAM shall notify COUNTY in writing of any change in the list of subgrantees/
subcontractors, vendors, personal service providers or subsidiaries of MENTORING PROGRAM within
fifteen (15) days of change.
9
33. HUD HOLD HARMLESS
MENTORING PROGRAM shall indemnify and hold harmless COUNTY against any liability,claims, losses,
demands, and actions incurred by COUNTY as a result of the determination by HUD or its successor that
activities undertaken by MENTORING PROGRAM under the programs) fail to comply with any laws,
regulations or policies applicable thereto or that any funds billed by and disbursed to MENTORING
PROGRAM under this Contract were improperly expended.
34. INDEMNIFICATION
MENTORING PROGRAM agrees to indemnify, defend and hold harmless COUNTY and its authorized
officers, employees, agents and volunteers from any and all claims, actions, losses, damages, and/or liability
arising from MENTORING PROGRAM acts, errors or omissions and for any costs or expenses incurred by
COUNTY on account of any claim therefore, except where such indemnification is prohibited by law.
MENTORING PROGRAM shall promptly notify COUNTY in writing of the occurrence of any such claims,
actions, losses, damages, and/or liability.
35. INSURANCE REQUIREMENTS
Without in any way affecting the indemnity herein provided and in addition thereto, MENTORING
PROGRAM shall secure and maintain throughout the Contract the following types of insurance with limits
as shown:
Workers'Compensation -A program of Worker's Compensation insurance or a State-approved Self
Insurance Program in an amount and form to meet all applicable requirements of the Labor Code of
the State of California, including Employer's Liability with $250,000 limits, covering all persons
providing services on behalf of MENTORING PROGRAM and all risks to such persons under this
Contract.
- Comprehensive General and Automobile Liability Insurance - This coverage to include contractual
coverage and automobile liability coverage for owned, hired, and non-owned vehicles. The policy
shall have combined single limits for bodily injury and property damage of not less than one million
dollars ($1,000,000).
Errors and Omissions Liability Insurance-Combined single limits of$1,000,000 for bodily injury and
property damage and $ 3,000,000 in the aggregate or
Professional Liabilitv-Professional liability insurance with limits of at least$1,000,000 per claim or
occurrence.
Additional Named Insured - All policies, except for Workers' Compensation, Errors and Omissions
and Professional Liability policies, shall contain additional endorsements naming COUNTY and its
officers, employees, agents, and volunteers as additional named insured with respect to liabilities
arising out of the performance of services hereunder.
Waiver of Subrogation Rights - Except for Errors and Omissions and Professional Liability,
MENTORING PROGRAM shall require the carriers of the above required coverage to waive all rights
of subroc ation against COUNTY, its officers, employees, agents, volunteers, contractors and
subcontractors.
10
Policies Primary and Non-Contributory - All policies required above are to be primary and non-
contributory with any insurance or self-insurance programs carried or administered by COUNTY.
36. INSURANCE DOCUiViENTATION
MENTORING PROGRAM shall immediately furnish certificates of insurance to ECD evidencing the
insurance coverage, including endorsements,above required prior to the commencement of performance of
services hereunder, which shall provide that such insurance shall not be terminated or expire without thirty
(30)days written notice to ECD, and MENTORING PROGRAM shall maintain such insurance from the time
MENTORING PROGRAM commences performance of services hereunder until the completion of such
services. Within sixty (60) days of the commencement of this Contract, MENTORING PROGRAM shall
furnish certified copies of the policies and all endorsements. iVIENTORING PROGRAM shall complete and
submit Contract Exhibit 4 of 7, INSURANCE INVENTORY, along with the above required insurance
documents. -
37. INSURANCE REVIEW
The above insurance requirements are subject to periodic review by COUNTY. The COUNTY'S Risk
Manager is authorized,but not required,to reduce or waive any of the above insurance requirements whenever
the Risk Manager determines that any of the above insurance is not available, is unreasonably priced,or is not
needed to protect the interests of COUNTY.
In addition, if the Risk Manager determines that heretofore unreasonably priced or unavailable types of
insurance coverage or coverage limits become reasonably priced or available,the Risk Manager is authorized,
but not required,to change the above insurance requirements,to require additional types of insurance coverage
or higher coverage limits, provided that any such change is reasonable in light of past claims against
COUNTY, inflation, or any other item reasonably related to the COUNTY'S risk.
Any such reduction or waiver for the entire term of the Contract and any change requiring additional types of
insurance coverage or higher coverage limits must be made by amendment to this Contract. MENTORING
PROGRAM agrees to execute any such amendment within thirty(30)days of receipt.
38. COMPLIANCE WITH LAWS
All parties agree to be bound by applicable federal, state, and local laws, ordinances, regulations, and
directives as they pertain to the performance of this Contract. This Contract is subject to and incorporates the
terms of the ACT; 24 Code of Federal Regulations, Part 570 and Part 84, Chapter V; and U.S. Office of
Management and Budget Circulars A-122, and A-133.
39. AMENDMENTS: VARIATIONS
This writing with attachments, embodies the whole of this Contract of the parties hereto. There are no oral
agreements not contained herein. Except as herein provided,addition or variation of the terms of this Contract
shall not be valid unless made in the form of a written amendment to this Contract formally approved and
executed by both parties.
11
40. NOTICES
All notices shall be served in writing. The notices shall be sent to the following addresses:
County of San Bernardino City of San Bernardino Mentoring Program
Department of Economic c/o Parks& Recreation Department
and Community Development 547 North Sierra Way
290 North "D" Street, Sixth Floor San Bernardino, CA 92410
San Bernardino, CA 92415-0040
41. COUNTERPART EXECUTION
This Contract may be executed in counterparts. When executed,each counterpart shall be deemed an original
irrespective of date of execution. Said counterparts shall together constitute one and the same Contract.
12
above. IN WITNESS WHEREOF,the parties have caused this Contract to be executed as of the day and year written
-
COUNTY OF SAN BERNARDINO CITY OF SAN BERNARDINO
MENTORING PROGRAM
By: By:
Chairman, Board of Supervisors Director, San Bernardino City Parks &
Recreation Department
Dated: Dated:
By:
Program Coordinator
Dated:
SIGNED AND CERTIFIED THAT A COPY OF
THIS DOCUMENT HAS BEEN DELIVERED TO
THE CHAIRMAN OF THE BOARD
EARLENE SPROAT
Clerk of the Board of Supervisors
of the County of San Bernardino
By:
Dated:
APPROVED AS TO LEGAL FORIv1
ALAN MARKS
County Counsel
By:
Dated:
AGNITS/96SWITY.2PT
08/20/96/AD/bjJ
13
EXHIBIT 1 of 7
COUNTY OF SAN BERNARDINO DEPARTMENT OF ECONOi HC AND COVLNIUNITY DEVELOPMENT
Project/Activity Title: Case Number: 350 - 22227/ 1554
Fifth District: Youth iVientoring Program -
San Bernardino (City) Parks&Recreation
Name/Address of Contractor Agencv: Date of Issue:
City of San Bernardino Mentoring Program -
San Bernardino City Parks & Recreation Department X Original: Beginning: Sept. 1, 1996
547 North Sierra Way
San Bernardino, CA 92410 Amendment#
PROJECT/ACTIVITY DESCRIPTION
SERVICES:
The MENTORING PROGRAM will establish a mentoring and support program for at-risk youth from seven (7)
middle schools (see attached list)within the unincorporated areas of the Fifth Supervisorial District and the City of
San Bernardino. This program will establish a Mentoring Advisory Board to include representatives from the business
community, local schools,civic leaders,churches, service clubs and local colleges. The MENTORING PROGRAM
will establish program partnerships between the Unified School District and volunteer members from the local
community to mentor at-risk youth. The program's primary goals are to assist the at-risk youth from the targeted
schools in improving their academic skills, and help the community by reducing the drop-out rate, preventing teen
pregnancy,reducing juvenile delinquency,curtailing the use of illegal drugs and decreasing the gang involvement rate.
At least 51%of the beneficiaries of the at-risk youth in the mentoring program shall be from low-and moderate-income
households. Approximately 4,775 students(72%)from the 7 middle schools'total population of 7,700 students have
been identified as being eligible, based on their previous ability to meet the requirements and qualify for the federally
subsidized, "Free or Reduced Cost Lunch Program".
OPERATIONS:
The MENTORING PROGRAM will provide one(1)contract staff person, identified as the Mentor Coordinator,whose
primary responsibility will be to coordinate the students,teachers,parents,volunteer mentors and community leaders
in all facets of program design, implementation, administration, and mentor recruitment. The 7 middle schools
involved under contract with the MENTORING PROGRAM will provide a resource person who will coordinate the
mentoring activities to be administered at the specific school sites. This will include training, identification,eligibility
and assignment of student mentees,coordination of schedules,procurement/arrangements for facilities and required
materials, and monitoring/documentation of volunteer hours, students' progress, teacher evaluations, etc.
Specific services to be provided under the terms of this contract are outlined in the"Units of Service"section below.
UNITS OF SERVICE:
1. Individual Student iVlentorinQ and Education Assistance Services: A projected monthly average of sixteen
jl 6) individualized mentoring/counseling sessions will be conducted. Each student attending an individual
mentoring/counseling/education assistance session shall represent one 1) unit of service.
EXHIBIT 1 of 7 (SuRpleme_ ntall
COUNTY OF SAN BERNARDINO DEPARTMENT OF ECONOTMC AND COMD4UNITY DEVELOPMENT
Project/Activity Title: Case Number: 350-22227/ 1554
Fifth District: Youth Mentoring Program -
San Bernardino(City)Parks& Recreation
Name/Address of Contractor Agency: Date of Issue:
City of San Bernardino Mentoring Program -
San Bernardino City Parks & Recreation Department X Original: Beginning: Sept. 1, 1996
547 North Sierra Way
San Bernardino, CA 92410 Amendment 9
MENTORING PROGRAM-ELIGIBLE SCHOOLS
NAME OF ELIGIBLE SCHOOL "FREE/ASSISTED LUNCH" TOTAL STUDENT PERCENT OF PROGRAM-
PROGRAM STUDENT COUNTS ENROLLMENT ELIGIBLE STUDENTS
1. Arrowhead 840 1015 83%
2. Curtis 923 1092 90%
3. Del Vallejo 727 913 80%
4. Golden Valley 730 1177 62%
5. M.L. King 728 962 76%
6. Serrano 628 1039 60%
7. Shandin Hills 643 1003 71%
TOTALS: 5219 7201 74.58%
EXHIBIT 2 of 7
COUNTY OF SAN BERNARDI O DEPARTNIENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
Project/Activity Title: Case Number: 350 - 22227/ 1554
Fifth District: Youth Nlentoring Program -
San Bernardino (City) Parks& Recreation
Name/Address of Contractor Agencv: Date of Issue:
City of San Bernardino Mentoring Program -
San Bernardino City Parks&Recreation Department X Original: Beginning: Sept. 1, 1996
547 North Sierra Way
San Bernardino, CA 92410 Amendment 9
BUDGET SUMMARY
COST CATEGORY CDBG SHARE$ OTHER SOURCES $* TOTAL COST$
1) Personnel: $ 0.00 $ 0.00 $ 0.00
2) Consultant/Contract 14,500.00 14,500.00 29,000.00
Services:
3) Travel: 0.00 0.00 0.00
4) Space Rental: 0.00 12,600.00 12,600.00
5) Consumable Supplies: 0.00 900.00 900.00
6) Rental, Lease, or 0.00 0.00 0.00
Purchase of Equipment:
7) Insurance: 0.00 0.00 0.00
8) Other: 5,000.00 4,500.00 9,500.00
0.00 0.00 0.00
TOTALS $ 19,500.00 $ 32,500.00 $ 52,000.00
*If costs are to be shared by other sources of funding, including CDBG funds from other jurisdictions, identify the
source of funding, grantor/lending agency,and cost category information.
SUMMARY - OTHER SOURCES OF FUNDING:
City of San Bernardino CDBG Program: S32,500
EXHIBIT 3 of 7
COUNTY OF SAN BERNARDINO DEPARTMENT OF ECONONUC AND CONUgUNITY DEVELOPMENT
Proiect/Activity Title: Case Number: 350 -22227/ 1554
Fifth District: Youth Mentoring Program-
San Bernardino (City)Parks& Recreation
Name/Address of Contractor Agency: Date of Issue:
City of San Bernardino Mentoring Program- X Original: Beginning: Sept. 1, 1996
San Bernardino City Parks & Recreation Department
547 North Sierra Way
San Bernardino, CA 92410 Amendment#
BUDGET JUSTIFICATION-PART I(SUPPLIES/SERVICES)
DESCRIPTION OF ITEM(S)AND BASIS FOR VALUATION CDBG COST$ TOTAL COST$
Budget line
Item #:
2. Consultant/Contract Services: $ 14,500.00 $ 29,000.00
(Consultant Contract for Program Coordinator)
4. Space Rental: 0.00 12,600.00
(Office Space w/Utilities Included)
5. Consumable Supplies: 0.00 900.00
(Office Supplies and Postage, etc.)
6. Rental. Lease. or Purchase of Equipment: 0.00 0.00
(General Office Equipt./No County CDBG)
8. Other: 5,000.00 9,500.00
(Individualized Services: Department of Justice Background
Reports, Copy Services, Delivery and Special Handling
Charges, etc.)
Totals: S 19,500.00 S 52,000.00
NOTE: Any budget line item(s)other than salaries and fringe benefits should be detailed above.
EXHIBIT 4 of 7
COUNTY OF SAN BER1vARDINO DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
Proiect/Activity Title: Case Number: 350 -22227/ 1554
Fifth District: Youth *vlentoring Program -
San Bernardino (City) Parks & Recreation
Name/Address of Contractor Agency: Date of Issue:
City of San Bernardino Mentoring Program -
San Bernardino City Parks &Recreation Department X Original: Beginning: Sept. 1, 1996
547 North Sierra Way
San Bernardino, CA 92410 Amendment#
INSURANCE INVENTORY
WORKERS' COMPENSATION/EMPLOYER'S LIABILITY INSURANCE
Name of Program State General Fund
Effective Dates Continuous
Employer's Liability Limit$ 1.000.000
Certificate of Insurance Attached Yes X No: On File w/ECD
COMPREHENSIVE AND GENERAL AUTOMOBILE LIABILITY INSURANCE
Name of Contractor's General Insurance Company City of San Bernardino- Self Insured Fund
Limits of Liability Effective Dates Continuous
Per Occurrence $ N/A Additional Insured Endorsement Attached Yes No: On File w/ECD
Annual Aggregate $ N/A Certificate of Insurance Attached Yes No: On File w/ECD
Name of Contractor's Automobile Liability Insurance Company Farmers Insurance
Limits of Liabilitv Effective Dates 04/17/96 to 04/17/97
Per Person $ Per Accident$ Damage Liability$ 760,000 Per Accident
ERRORS AND OMISSIONS LIABILITY INSURANCE
Name of Contractor's Insurance Company City of San Bernardino- Self Insured
Limits of Liabilitv Effective Dates N/A
Per Occurrence �_ Additional Insured Endorsement Attached Yes _No: On File w/ECD
Annual Aggregate S Certificate of Insurance Attached Yes _No: On File w/ECD
PROFESSIONAL LIABILITY INSURANCE
Name of Contractor's Insurance Company State Farm Insurance EYchanae
Limits of Liability Effective Dates 04/17/96 to 04/17/97
Per Occurrence $ 1.000.000 Additional Insured Endorsement Attached Yes X No: On File w/ECD
Annual Aggregate $100.000 Certificate of Insurance Attached Yes X No: On File w/ECD
EXHIBIT 5 of 7
COUNTY OF SAN BERNARDINO DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
Proiect/Activity Title: Case Number: 350-22227/ 1554
Fifth District: Youth Mentoring Program -
San Bernardino(City)Parks&Recreation
Name/Address of Contractor AQencv: Date of Issue:
City of San Bernardino Mentoring Program -
San Bernardino City Parks& Recreation Department X Original: Beginning: Sept. 1, 1996
547 North Sierra Way
San Bernardino, CA 92410 Amendment#
MONTHLY PROGRAM PROGRESS REPORT-PART B For the Month of ' 199
Date: #of Children: #of Adults: Name of Qualifying School(s): TOTAL:
MONTHLY TOTAL:
NOTE: Figure must match monthly reimbursement request.
Signed Title Date
Print Name Tel.Number/Est.:
EXHIBIT 6 of 7
COUNTY OF SAN BERNARD1N0 DEPARTMENT OF ECONOMIC AND COM IUMTY DEVELOPMENT
Proiect/Activity Title: Case Number: 350-22227/ 1554
Fifth District: Youth Nfentoring Program -
San Bernardino (City)Parks&Recreation
Name/Address of Contractor Agency: Date of Issue:
City of San Bernardino Nientoring Program -
San Bernardino City Parks & Recreation Department X Original: Beginning: Sept. 1, 1996
547 North Sierra Wav
San Bernardino, CA 92410 Amendment 4
BENEFICIARY QUALIFICATION STATEMENT
This form has the purpose of providing information needed to qualify the use of Federal Community Development Block Grant
(CDBG)funds for the project/activity described above. This statement must be completed and signed by the person(legal guardian)
requesting to receive benefits from the described project/activity.
Please answer each of the following questions.
1. For this question a household is a group of related or unrelated persons occupying the same house with at least one member
being the head of the household. Renters,roomers, or borders cannot be included as household members. How many
persons are in your household?
2. For this question a list of the 1996-97 LOW AND MODERATE income categories* are presented below. Please
calculate the combined Bross annual income of all persons in your household from all sources of income.
State,yes or no,if your combined gross annual income is equal to or less than the LOW amount for the number of
persons in your household.
State,yes or no, if your combined gross annual income is equal to or less than the MODERATE amount for the
number of persons in your household.
Number of Persons in Your Household
1 2 3 4 5 6 7 8
L OW $ 15,150 $ 17,300 $ 19,500 S 21,650 $23,400 S 25,100 $26,850 S 28,600
MODERATE S 24,250 S 27,700 $31,200 $34,650 $37,400 $40,200 $42,950 $45,700
3. Do you identify yourself as:
White Black Hispanic American Indian Asian Other
4. Please state, yes or no, if you are a female Head of Household?
5. Please describe the condition that would qualify you as being considered in one of the following categories: low-
and moderate-income household, abused child, battered spouse, elderly person, homeless person, disabled person,
illiterate person, or migrant farm worker.
ACKNOWLEDGMENT AND DISCLAIMER
I CERTIFY UNDER PEN.UTY OF PERJURY THAT INCOME AND HOUSEHOLD STATENtENTS IvL-kDE ON THIS FOR,NI ARE TRUE.
NAME: DATE:
ADDRESS: PHONE NO:
SIGNATURE:
The information you provide on this form is for Community Development Block Grant(CDBG)program purposes only and will be kept confidential.
*Taken from Section 8 1996-97 Low and Very Low Income Limits.
EXHIBIT 7 of 7
COUNTY OF SAN BERNARDINO DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
Proiect/Activity Title: Case Number: 350 -22227/ 1554
Fifth District: Youth Mentoring Program -
San Bernardino(City)Parks&Recreation
Name/Address of Contractor Agencv: Date of Issue:
City of San Bernardino Mentoring Program -
San Bernardino City Parks & Recreation Department X Original: Beginning: Sept. 1, 1996
547 North Sierra Way
San Bernardino, CA 92410 Amendment#
MONTHLY PROGRAM PROGRESS REPORT For the Month of , 199
Under each type of service listed below,describe what your program has accomplished during this month. Include location,
number of persons served, services/benefits provided, and a description of the clients served. Also report the number of
"Units of Service" provided as defined in the Program/Project Description(Exhibit 1).
Type of Service: Anticipated Units of Service:
1. Individual Student Mentorina& Education Assistance Services: Goal/mo.: 16 Actual/mo.:
Total Number of Households or Persons Served During This Month
(Above figures may include individuals previously counted during this grant/program year.)
MONTHLY DIRECT BENEFIT REPORT
(Unduplicated first-time client counts only)
Program beneficiaries are counted below as: Households(H✓)_or Persons(P✓)_
Number of Households or Persons Directly Assisted:
Low Income (ONLY) Low and Moderate Income(COMBINED TOTAL)
Counts By Race/Ethnicity (The total of these counts should equal the combined total above):
White,Not Hispanic Origin Black, not Hispanic Origin
Hispanic American Indian/Alaskan Native
Asian Pacific Islander Other: (Specify) /
Female Headed Households: (Do NOT Duplicate this Countw/ Categories)
Signed Title Date
Print Name Tel.No./Ext.