HomeMy WebLinkAboutRFP - 9189 HOUSING STRATEGIC PLANRFP 9189 HOUSING STRATEGIC PLAN Page 1 of 39
REQUEST FOR PROPOSAL
9189 HOUSING STRATEGIC PLAN
RFP DUE: 3:00 PM MST (our clock), SEPTEMBER 18, 2020
The City of Fort Collins is requesting proposals from qualified Consultants to support the
development of a framework to identify and evaluate strategies to be adopted as part of a newly
adopted Housing Strategic Plan.
As part of the City’s commitment to Sustainable Purchasing, proposals should be submitted
online through the Rocky Mountain E-Purchasing System (RMEPS) at
http://www.bidnetdirect.com/colorado/city-of-fort-collins. Note: please ensure adequate time to
submit proposals through RMEPS. Proposals not submitted by the designated Opening Date
and Time will not be accepted by the system.
All questions should be submitted in writing via email, to Marisa Donegon, Buyer, at
mdonegon@fcgov.com no later than 5:00 PM MST (our clock) on September 9, 2020.
Please format your email to include: 9189 Housing Strategic Plan in the subject line.
Respondent communication regarding the proposal with other City personnel is prohibited and
shall be grounds for disqualification. Responses to all questions submitted before the deadline
will be addressed in an addendum and posted on the Rocky Mountain E-Purchasing System
webpage.
Rocky Mountain E-Purchasing System hosted by BidNet
A copy of the RFP may be obtained at http://www.bidnetdirect.com/colorado/city-of-fort-collins.
This RFP has been posted utilizing the following Commodity Code(s):
91827 Community Development Consulting
91858 Governmental Consulting
91863 Housing Consulting
91865 Human Relations Consulting
Prohibition of Unlawful Discrimination: The City of Fort Collins, in accordance with the
provisions of Title VI of the Civil Rights Act of 1964 (78 Stat. 252, 42 US.C. §§ 2000d to 2000d-
4) and the Regulations, hereby notifies all bidders that it will affirmatively ensure that any
contract entered into pursuant to this advertisement, disadvantaged business enterprises will be
afforded full and fair opportunity to submit bids in response to this invitation and will not be
discriminated against on the grounds of race, color, or national origin in consideration for an
award.
The City strictly prohibits unlawful discrimination based on an individual’s gender (regardless of
gender identity or gender expression), race, color, religion, creed, national origin, ancestry, age
40 years or older, marital status, disability, sexual orientation, genetic information, or other
characteristics protected by law. For the purpose of this policy “sexual orientation” means a
person’s actual or perceived orientation toward heterosexuality, homosexuality, and bisexuality.
The City also strictly prohibits unlawful harassment in the workplace, including sexual
harassment. Further, the City strictly prohibits unlawful retaliation against a person who
engages in protected activity. Protected activity includes an employee complaining that he or
she has been discriminated against in violation of the above policy or participating in an
employment discrimination proceeding.
Financial Services
Purchasing Division
215 N. Mason St. 2nd Floor
PO Box 580
Fort Collins, CO 80522
970.221.6775
970.221.6707
fcgov.com/purchasing
RFP 9189 HOUSING STRATEGIC PLAN Page 2 of 39
The City requires its vendors to comply with the City’s policy for equal employment opportunity
and to prohibit unlawful discrimination, harassment and retaliation. This requirement applies to
all third-party vendors and their subcontractors at every tier.
Public Viewing Copy: The City is a governmental entity subject to the Colorado Open Records
Act, C.R.S. §§ 24-72-200.1 et seq. (“CORA”). Any proposals submitted hereunder are subject
to public disclosure by the City pursuant to CORA and City ordinances. Vendors may submit
one (1) additional complete proposal clearly marked “FOR PUBLIC VIEWING.” In this version
of the proposal, the Vendor may redact text and/or data that it deems confidential or proprietary
pursuant to CORA. Such statement does not necessarily exempt such documentation from
public disclosure if required by CORA, by order of a court of appropriate jurisdiction, or other
applicable law. Generally, under CORA trade secrets, confidential commercial and financial
data information is not required to be disclosed by the City. Proposals may not be marked
“Confidential” or ‘Proprietary’ in their entirety. All provisions of any contract resulting from
this request for proposal will be public information.
New Vendors: The City requires new Vendors receiving awards from the City to fill out and
submit an IRS form W-9 and to register for Direct Deposit (Electronic) payment. If needed, the
W-9 form and the Vendor Direct Deposit Authorization Form can be found on the City’s
Purchasing website at www.fcgov.com/purchasing under Vendor Reference Documents. Please
do not submit with your proposal.
Sales Prohibited/Conflict of Interest: No officer, employee, or member of City Council, shall
have a financial interest in the sale to the City of any real or personal property, equipment,
material, supplies or services where such officer or employee exercises directly or indirectly any
decision-making authority concerning such sale or any supervisory authority over the services to
be rendered. This rule also applies to subcontracts with the City. Soliciting or accepting any gift,
gratuity favor, entertainment, kickback or any items of monetary value from any person who has
or is seeking to do business with the City of Fort Collins is prohibited.
Collusive or Sham Proposals: Any proposal deemed to be collusive or a sham proposal will
be rejected and reported to authorities as such. Your authorized signature of this proposal
assures that such proposal is genuine and is not a collusive or sham proposal.
The City of Fort Collins reserves the right to reject any and all proposals and to waive any
irregularities or informalities.
Utilization of Award by Other Agencies: The City of Fort Collins reserves the right to allow
other state and local governmental agencies, political subdivisions, and/or school districts to
utilize the resulting award under all terms and conditions specified and upon agreement by all
parties. Usage by any other entity shall not have a negative impact on the City of Fort Collins in
the current term or in any future terms.
The selected Vendor shall be expected to sign the City’s standard Agreement prior to
commencing Services (see sample attached to this Proposal).
Sincerely,
Gerry Paul
Purchasing Director
RFP 9189 HOUSING STRATEGIC PLAN Page 3 of 39
I. INTRODUCTION
The City of Fort Collins (City) is committed to ensuring there are attainable and safe housing
options for all Fort Collins community members across the housing spectrum and is
developing a five year Housing Strategic Plan (HSP) to ensure that everyone in Fort Collins
has stable and healthy housing they can afford. Accordingly, the City is requesting
proposals from qualified Consultants to support the development of a framework to identify
and evaluate potential strategies to be included in the HSP that will achieve the vision.
The anticipated period of performance for this project is October 2020- May 2021.
II. PURPOSE AND GOALS
In 2020 the City is developing an HSP to address issues related to available affordable,
attainable, safe and healthy housing options in the Fort Collins community. The overall
vision for the HSP is that everyone will have stable and healthy housing they can afford.
This vision allows for the City to work towards a universal outcome with targeted strategies
across the housing spectrum. Consistent with the City’s 2020 Strategic Plan Strategic
Objective, this planning effort will be centered in equity, leading with race, ensuring that all
community members are able to enjoy housing that is healthy, stable, and affordable for
them.
The goal of this RFP is to identify a qualified Consultant to identify strategies, develop an
evaluation framework that can be applied to prioritize individual strategies, and support
evaluation of strategies to be included in the HSP. This will include the following
considerations:
a. Recognizing that housing is a complex issue, based on existing conditions and
feedback to date from community members, diverse strategies will be needed to
reach the overall outcome. Consultants will collaborate with the City and other
stakeholders to identify high level housing strategies. This will include but not be
limited to:
o Assembling and reviewing baseline conditions, or current practices and
status of affordable housing programs within Fort Collins.
o Review community input and identify best practices and innovative strategies
used in peer communities and elsewhere. Examples locally, nationally, and
internationally should be considered.
o In collaboration with City staff, review “buckets” or categories that high-level
strategies will be placed in for the HSP.
b. Develop an evaluation framework by which different strategies can be evaluated
against revised goals, metrics and targets to be prioritized for inclusion in the HSP.
o The evaluation framework will include criteria and a rating system that will
assist in prioritization in alignment with metrics, targets and indicators.
c. Provide documentation regarding development and use of the evaluation framework,
and support City staff in using the framework to evaluate and prioritize strategies to
be included in the HSP.
o Recognizing the complex and ever-changing nature of conditions affecting
the housing system, the evaluation framework must be adaptable to future
use by City staff.
The ideal Consultant will have familiarity with the unique challenges and opportunities in
Fort Collins and expertise in how leading-edge cities are addressing housing needs across
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the housing spectrum. Because this work is being led with equity, incorporating equity
indicators into the evaluation framework will be a primary focus for evaluation.
III. BACKGROUND
This work will support the City with developing a comprehensive HSP, identifying strategies
to increase safe and healthy housing choices across the housing spectrum and building
upon existing plans and policies. The City developed its first Affordable Housing Strategic
Plan in 1999 to stimulate housing production for the City’s lowest wage earners (under 80%
of the area median income, or AMI). Last updated in 2014, the City’s Affordable Housing
Strategic Plan set ambitious goals to have 10% of the City’s housing inventory be affordable
by 2040. A goal to increase the ratio from 5% to 6% was set for the term of the Affordable
Housing Strategic Plan, 2015-2019.
The 2014 Affordable Housing Strategic Plan is bolstered by a significant commitment to
addressing housing affordability in many community plans and policies, including but not
limited to the following:
• Affordable Housing Redevelopment
Displacement Mitigation Strategy (2013)
• Housing Affordability Policy Study
(2014)
• Affordable Housing Strategic Plan
(2015)
• Social Sustainability Strategic Plan
(2016)
• City Plan (2019)
• Council Priorities (2019-2021)
• City Strategic Plan (2020)
• Analysis of Impediments to Fair Housing
Choice (2020)
• Fort Collins Consolidated Plan FY2020-
2024
• Additional efforts underway.
o Home2Health (2019-2021)
o Our Climate Future (2019-2021)
As a City and with our community partners, these plans and policies are backed by
interdependent regulatory, partnership and investment solutions including, but not limited to,
the following:
• Regulatory - Reduced the minimum house size required by the Land Use Code;
manufactured housing zone established; and metropolitan district policy review underway.
• Partnerships – Strong local housing authority, Housing Catalyst, which has developed
Fort Collins’ first permanent supportive housing project Redtail Ponds, and is completing
its second, Mason Place, on track for opening in December 2020; solidified important
new partnerships such as Elevations Community Land Trust.
• Investments - Ongoing efforts, such as investing between $1.5 - $3 million in federal
Community Block Grant (CDBG) and HOME Investment Partnership (HOME) funding, ;
secured $4 million over ten years via the Affordable Housing Capital Fund (CCIP);
activated the Land Bank program resulting in 96 new permanently affordable rental units
and adding a new five acre land bank parcel; and continuous improvement of assessing
opportunities to adapt and expand incentives for affordable housing specifically.
Why the Housing Strategic Plan now?
While significant progress has been made (373 homes added in the last 5 years with 248 under
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construction), Fort Collins is still short of the overall affordable housing goal (need approximately
300 units per year to hit the overall goal of 10% of units affordable by 2040).
At the same time, the gap between median income and median home price is widening - making
housing affordability for all residents a challenge. As with many cities across the nation and
globally, Fort Collins is experiencing a lack of availability of "missing middle" housing options
(range of housing types) and a lack of affordable housing options for moderate-income residents
(80-120% AMI).
Further, the most recent Social Sustainability Gaps Analysis (2020) highlights the following
housing affordability challenges in Fort Collins:
• There are 7,000 homeowners (21% of all owners) in Fort Collins that cannot afford their
monthly housing costs. In addition, renters wanting to buy have very few options in the
market until they earn around $75,000 per year and can afford homes priced at $280,000
or higher.
• Between 2012-2018, Fort Collins renter households earning less than $25,000 decreased
by nearly 3,000 households, while households earning more than $75,000 increased by
nearly 4,000 households.
o 8,790 renters in Fort Collins earn less than $25,000 (4,090 excluding student
households) with only 1,525 units that are affordable - meaning there is a 7,265-
unit gap.
o This points out a mismatch in the cost of rental inventory in the City to the area
median incomes of renter households. Many people are rent burdened meaning
they are paying more than 30%, or sometimes more than 50%, of their income on
housing costs.
• 60% of homebuyers who participated in the Department of Housing and Urban
Development’s (HUD) Neighbor-to-Neighbor’s (N2N’s) homebuyer education program
purchased a home outside of the City.
• There are higher poverty rates for all communities of color in Fort Collins and lower median
incomes for African American and Hispanic residents.
• In addition, while more challenging to quantify, there is a significant need for more
accessible units in Fort Collins for residents with ambulatory disabilities.
Still, while Northern Colorado is attracting people and developers are responding, most
multifamily production is market rate. Competition has increased for affordable housing
developers for land, required subsidy and funding programs like low income housing tax credits.
Some of these challenges must be addressed at the state or federal level.
In addition to these data points, community members shared the following feedback on what they
believe should be prioritized:
• Affordable, Stable Housing: Partners reported many residents have had to choose
between healthcare, housing, and other necessities like food or paying bills. Increases in
rent, costs of home maintenance/repair, and high cost of housing compared to income
were main themes. This feedback is bolstered by the fact that an estimated 17,300
households in Fort Collins are renting apartments or homes that they cannot afford (Social
Sustainability Gaps Analysis, 2020).
• Healthy Housing: Living conditions that are detrimental to health and well-being,
including persistent problems with pests or mold, deferred home maintenance, and feeling
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unsafe, were all mentioned related to the quality of housing in Fort Collins. Participants
also emphasized the importance of social elements of housing for overall health (e.g.
community, neighborhood). The quality of the built environment was another key element
of healthy housing identified by participants. This quality includes the ability to live close
to work or school, access to amenities, proximity to transit and ability to bike, which is a
key element of the City Plan (link above).
• Housing Choices and Supply: Housing availability is limited in Fort Collins, which is
consistent with prior feedback. Older adults interested in downsizing to smaller, accessible
units expressed concern they would not be able to find appropriate housing in their price
ranges. Additional housing options, including accessory dwelling units, could help older
adults age-in-place or move to housing that could help them remain independent.
Similarly, younger people who were renting identified there are not many affordable
options on the market for renters wanting to move or buy their first homes.
• Desire for Listening and Concrete Action: Participants were eager to see changes to
policies/programs and tangible actions. Participants indicated a desire to be heard and for
local government to take residents’ concerns who experience housing challenges more
seriously.
This sampling of data points, and the feedback from the community highlight why new and
innovative strategies and approaches are needed to address housing affordability in Fort Collins.
IV. FOCUS OF EFFORT
This planning effort will move from kickoff to adoption in just seven months (with an
additional three to four months to support development of implementation plan and further
evaluation). The City’s adopted goals, plans, and policies establish a strong foundation for
this HSP. Critical will be ensuring alignment across goals and policies via the triple bottom
line, e.g., that healthy, stable, and affordable housing includes how the HSP aligns with the
City’s economic development, and environmental goals (including carbon neutrality and air
quality).
For this work, and in order to identify and evaluate high-level strategies that will enable Fort
Collins to achieve its goals, several areas of focus will be prioritized:
Equity
This planning process is focused on universal outcomes with targeted strategies and will
be centered in equity, leading with race, ensuring that all community members are able to
enjoy housing that is healthy, stable, and affordable for them. From an outcome
perspective, the City will focus both on how the selected strategies address existing
inequities and how the final HSP outcomes will benefit everyone (i.e., ensure strategies
identified in the HSP are diverse enough to meet needs of community members along the
housing spectrum).
Prioritized Solutions Across Housing Spectrum
One of the most consistent messages staff has heard from the community is that, because
the housing system is so complex with so many drivers and levers, we need to prioritize
interventions and clearly identify how we will hold ourselves accountable for
implementation with metrics, roles (who is doing what), costs, and transparent
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accountability structures. The HSP must also be agile and responsive to changing
conditions and economics, e.g., how will priorities shift over time?
Long-term Partnerships
Achieving community goals and priorities will require more actors than local government
alone. A key aspect of this planning process is identifying the various stakeholders and
levels, e.g., community, statewide, national, etc., at which action should take place. The
final strategies listed in the HSP will identify who should lead each strategy, and the role
of local government. Strategies that can be led in partnerships should be identified.
V. SCOPE OF PROPOSAL
The draft Scope of Work outlined below provides guidance for responding consultant teams
by outlining the major elements the City has identified for this effort. That said, the City
anticipates that this Scope of Work will be revised and finalized collaboratively after
Consultant selection. The City encourages innovative and thoughtful proposals that
demonstrate understanding of the tasks outlined as well as other potential creative and
forward-thinking ideas and tasks that may be beneficial to incorporate during the work plan
finalization task.
This is a cooperative effort that will be managed between the City’s Sustainability and
Planning, Development, and Transportation (PDT) Service Areas. The selected Consultant
will confer/meet with the project members on a regular basis to review progress, present
deliverables and findings, and solicit direction.
Task 1: Project Kickoff and Coordination
The selected Consultant will meet with City staff to finalize the work plan together and integrate
project team members to align workstreams and check in regularly. This will include, at a
minimum, the following elements:
a. Presentation of the proposed final scope of work with detailed tasks and objectives
b. Detailed schedule identifying key milestones and deliverables
c. Staffing plan outlining consultant and City staff roles
d. Check- ins with HSP core team to discuss contents of the draft HSP including the
Existing Conditions document, goals for the HSP and “buckets” or categories that high-
level strategies will be placed in.
Estimated Schedule: November 9-23
Deliverables: Staffing plan outlining key milestones, deliverables and roles of Staff and
Consultant
Task 2: “Bucket” and High-level Strategy Identification and Revision of Goals
Primary responsibility: Consultant with City staff support
Based on existing local conditions, best practice research and themes heard from community
input, staff will create buckets that different strategies can fall into. Examples of bucketed areas
include:
a. Strategies across AMI (area median income) levels, e.g., below 30% AMI, 30-80% AMI,
80-120% AMI, 120% and above
b. Strategies by main lever needed, e.g., financing, regulatory, advocacy at federal and
state levels
c. Strategies by target populations
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It is expected that the Consultant will:
a. Identify best practices and innovative strategies used in peer communities
b. Review the existing conditions developed by staff and review community input to date
c. Based on research of best practices, provide feedback on “buckets” identified by staff
and suggest changes based on expertise
Once “buckets” have been chosen and agreed upon, City staff will review the goals of the HSP
with Consultant. The goals will be updated to ensure that they are aligned with community and
Council expectations and the Consultants will identify potential metrics, targets and indicators
for each of the goals to ensure effective implementation. Staff will lead engagement efforts with
the community to receive feedback on the overall “buckets” and goals.
Estimated Schedule: Week of November 23
Deliverables: Document summarizing best practices and list of innovative strategies used in
peer cities, document describing the recommendations made to City staff for “buckets” and a list
of potential metrics, targets and indicators to reach goals.
Task 3: Development of Evaluation Framework
Primary Responsibility: Consultant with City staff support
It is expected at a minimum 20 strategies will be evaluated and several considerations must be
included in the evaluation framework. These considerations include:
a. If strategy aligns with overall vision and goals of the HSP
b. Looking across strategies, are choices diverse enough to ensure that there will be
targeted approaches to reaching overall outcome across the housing spectrum?
a. Are there strategies that fit into different bucketed areas identified?
b. Are they diverse in terms of who will potentially lead the strategy
implementation?
c. Are strategies achieving more equitable outcomes for community members?
Who benefits and who is burdened by each strategy?
d. Identify how federal CDBG/HOME funds can be utilized for strategies
Given the timeframe for HSP adoption, tactics and specific actions to implement strategies will
not be specified in the HSP. The Consultant will be asked to have completed a draft evaluation
framework for plan adoption and to deliver a final evaluation framework for the implementation
plans and evaluation of strategies. Tasks are outlined below.
Task 3a: Draft Evaluation Framework for Housing Strategic Plan
The Consultant is tasked with providing a draft evaluation framework for HSP adoption that
includes criteria and a rating system that will assist in prioritization and alignment of strategies to
goals. Because these are high-level, there is not an expectation to evaluate every piece of data
for potential strategies quantitatively. Considerations when developing the evaluation framework
include, but are not limited to:
a. The impact of prioritized strategies as measured by both equity and financial
components
a. Equity: who is benefitting from the strategy? What (if any) are the disparate
impacts from strategy?
b. Financial: How does the strategy impact the cost to individuals in comparison to
another? Which sectors are impacted?
b. Is the strategy feasible?
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a. Support from community partners and City Council
b. Cost related to implementation.
c. Is strategy measurable?
a. How will the strategy relate to the goals set and how will we know if we are on or
off track? Are measures quantitative or qualitative or both?
b. Consider short-term, mid-term and long-term goals
Note that City staff will lead the creation of the criteria, with input from the community and
the consultant team.
Estimated Schedule: December-February
Deliverables:
• Draft evaluation framework with criteria and rating system that identifies strategies
for the plan and how they align with plan goals (November)
• At least 20 strategies evaluated for HSP (December)
• Revisions to the framework and strategies based on community feedback and final
inclusion in the plan (January/early February)
Task 3b: Final Evaluation Framework for Implementation Plan and Evaluation of
Strategies
After HSP adoption, City staff will begin to develop implementation plans for strategies listed in
the HSP. At a minimum, it is expected that the evaluation framework can prioritize high-level
strategies for HSP adoption and can also be scaled down to evaluate next-level strategies and
implementation at a more granular level. Consultant will support City staff in evaluating high-
level strategies and will provide recommendations on the best way to track progress for
implementation plans by helping to identify:
a. Metrics for each strategy
b. Short, mid and long-term goals for each strategy so that targets can be identified in the
implementation plans
For prioritized strategies, the Consultant will also support development of an accountability
structure including roles (who would lead the effort), costs and transparent accountability
structures. This information will be utilized in the development of implementation plans for each
of the strategies.
Schedule: February-May 2021
Deliverables: Final Evaluation framework that can be adapted in house by City staff, metrics
and targets used in implementation plans, accountability structure in implementation plans
Task 4: Summaries of Evaluation Framework Development and Support Drafting
Implementation Plans
Primary Responsibility: Consultant with City staff support
Consultant will provide summary of work that was done including process on how criteria was
selected for evaluation framework, how decisions were made, and recommendations for
process improvements and next steps.
Estimated Schedule: May 2021
Deliverables: Final summary report and debrief meeting with City staff team
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VI. ADDITIONAL INFORMATION
A. ANTICIPATED SCHEDULE
The following represents the City’s target schedule for the RFP. The City reserves the right to
amend the target schedule at any time.
• RFP issuance: August 31, 2020
• Question deadline: 5:00 PM MST on September 9, 2020
• Proposal due date: 3:00 PM MST on September 18,
2020
• Interviews (tentative): September 30 - October 9, 2020
• Award of Contract: Week of October 19, 2020
• Kick-off Meeting: Week of November 9,2020
• Final Deliverables due: Week of May 24, 2021
B. Budget
The budget for this proposal is limited to a maximum of $50,000. Consultants are invited
to submit proposals with the tasks prioritized to aid the City in working together with the
selected Consultant to identify and implement core tasks within the budget available for
this project.
C. Interviews
In addition to submitting a written proposal, the top-rated Consultants may be interviewed
by the RFP assessment team and asked to participate in an oral presentation to provide
an overview of the company, approach to the project and to address questions. The
evaluation criteria for the oral interviews will be the same as the criteria for the written
evaluations and is included in Section VIII.
D. Travel & Expenses
Consultants are to provide a list of fees for reimbursable expenses. Reasonable
preapproved expenses will be reimbursable per the current rates found at www.gsa.gov.
E. Sub-Consultants
Consultants will be responsible for identifying any sub-consultants in their proposal.
Please note that the City will contract solely with the awarded Consultant; therefore sub-
consultants will be the responsibility of the Consultant.
F. Fees, Licenses, Permits
The successful Consultant shall be responsible for obtaining any necessary licenses, fees
or permits without additional expense to the City. All equipment shall be properly licensed
and insured, carry the appropriate permits and be placarded as required by law.
G. Laws and Regulations
The Consultant agrees to comply fully with all applicable local, State of Colorado and
Federal laws and regulations and municipal ordinances.
H. Invoicing and Payment
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Invoices should be emailed monthly to invoices@fcgov.com with a copy to the Project
Manager. The cost of the work completed shall be paid to the Consultant each month
following the submittal of a correct invoice by the Consultant indicating the project name,
Purchase Order number, task description, hours worked, personnel/work type category,
hourly rate for each employee/work type category, date of the work performed specific to
the task, percentage of that work that has been completed by task, 3rd party supporting
documentation with the same detail and a brief progress report.
The City pays invoices on Net 30 terms.
VII. PROPOSAL SUBMITTAL
Please limit the total length of your proposal to a maximum of twenty (20) double sided or forty
(40) single sided 8 ½ x 11” pages (excluding cover pages, table of contents, resumes, dividers
and Consultant Statement form). Font shall be a minimum of 10 Arial and margins are limited
to no less than .5” for sides and top/bottom. Extended page sizes, such as 11” x 17”, count as
a single page. Please, no embedded documents. Proposals that do not conform to these
requirements may be rejected
For this section, Consultants are required to provide detailed written responses to the following
items in the order outlined below. The responses shall be considered technical offers of what
Consultants propose to provide and shall be incorporated in the contract award as deemed
appropriate by the City. A proposal that does not include all the information required may be
deemed non-responsive and subject to rejection.
Responses must include all the items in the order listed below. It is suggested that the
Consultants include each of the City’s questions with their response immediately following the
question.
The City of Fort Collins shall not reimburse any firm for costs incurred in the preparation and
presentation of their proposal.
A. Cover Letter / Executive Summary
The Executive Summary should highlight the content of the proposal and features of the
program offered, including a general description of the program and any unique aspects
or benefits provided by your firm.
Indicate your availability to participate in the interviews/demonstrations on the proposed
dates as stated in the Schedule section.
B. Consultant Information
1. Describe the Consultant’s business and background
2. Number of years in the business
3. Details about ownership
4. An overview of services offered and qualifications
5. Size of the firm
6. Location(s) of offices. If multiple, please identify which will be the primary for our
account.
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7. Primary contact information for the company including contact name(s) and title(s),
mailing address(s), phone number(s), and email address(s). Complete Section IX,
Consultant Statement.
C. Scope of Proposal
1. Provide a detailed narrative of the services proposed if awarded the contract per the
information above. The narrative should include any options that may be beneficial
for the City to consider.
2. Describe how the project would be managed and who would have primary
responsibility for its timely and professional completion. Include a description
regarding how the evaluation framework will be developed, including how the
associated analysis will be performed for the various identified areas identified, the
methods and assumptions used, and the limitations of the analysis/approach.
3. Identify what portion of work, if any, may be subcontracted.
4. It is expected that this project will be a highly collaborative effort. City staff will be
working closely with the awarded Consultant on all aspects of the planning process
and in some cases leading elements of the study. Within your response please
include how you would work with City staff to conduct the scope of work in an effort
to save costs wherever possible.
D. Firm Capability
Provide relevant information regarding previous experience related to this or similar
Projects, to include the following:
1. Provide an Organization Chart/Proposed Project Team: An organization chart
containing the names of all key personnel and sub consultants with titles and their
specific task assignment for this Agreement shall be provided in this section.
2. A list of qualifications for your firm and qualifications and experience of the specific
staff members proposed to perform the consulting services described above.
3. Provide a minimum of three similar projects with public agencies in the last 5 years
that have involved the staff proposed to work on this project. Include the owner’s
name, title of project, beginning price, ending price, contact name, email and phone
number, sub-consultants on the team and a brief description of the work, including
how this work applied an equity lens or was centered in equity, and any change
orders. The Consultant authorizes City to verify any and all information contained in
the Consultant’s submittal from references contained herein and hereby releases all
those concerned providing information as a reference from any liability in connection
with any information they give.
4. If applicable, provide examples of at least two projects where you’ve worked with
your sub-consultants. List the sub-consultant firm(s) for this Agreement, their area(s)
of expertise, and include all other applicable information herein requested for each
sub-consultant. Identify what portion of work, if any, may be sub-contracted.
5. References (current contact name, current telephone number and email address)
from at least three similar projects with similar requirements that have been
completed within the past five (5) years and that have involved the staff proposed to
work on this project. Provide a description of the work performed. The Consultant
authorizes City to verify any and all information contained in the Consultant’s
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submittal from references contained herein and hereby releases all those concerned
providing information as a reference from any liability in connection with any
information they give.
E. Assigned Personnel
1. List of Project Personnel: This list should include the identification of the contact
person with primary responsibility for this Agreement, the personnel proposed for this
Agreement, and any supervisory personnel, including partners and/or sub
consultants, and their individual areas of responsibility.
2. A resume for each professional and technical person assigned to the Agreement,
including partners and/or sub consultants, shall be submitted. The résumés shall
include at least three individual references from previous assignments. Please limit
resumes to one page including experience in housing, development of evaluation
frameworks, and experience in applying an equity lens.
3. Some functions of this project may require the use of sub-consultants. If you intend
to utilize sub-consultants you must list each and provide resumes for their key
personnel.
4. Describe the availability of project personnel to participate in this project in the
context of the Consultant’s other commitments.
5. Provide a list of similar projects completed in the last five (5) years by the key
members of the proposed team.
F. Availability
1. Are other qualified personnel available to assist in meeting the project schedule if
required?
2. Is the project team available to attend meetings as required by the Scope of Work?
3. Provide a project schedule showing key milestones, and deliverable dates.
4. Can the work be completed in the necessary timeframe, with target start and
completion dates met?
5. Describe the methods and timeline of communication your firm will use with the
City’s Project Manager and other parties.
G. Sustainability/TBL Methodology
In concise terms (no more than two pages), please describe your organization’s
commitment to sustainability and supporting values. Address how your firm strives to
incorporate all three aspects (social, environmental, and economic) of Triple Bottom Line
(TBL) sustainable practices into the workplace. Provide examples along with any metrics
used to measure success within your firm.
Also provide examples of how your firm has incorporated all three aspects of TBL
sustainable practices in previous similar projects.
Some examples are provided below:
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1. Environmental – Experience delivering projects / programs focused on
environmental health priorities in the areas of climate resiliency, water quality and
watershed protection, regulatory performance, management systems, air quality,
renewable energy, sustainable building and design, construction materials
management, and solid waste reduction.
2. Economic – Experience working and delivering projects with an emphasis on
strategic financial planning, job creation, business development, asset management,
various project delivery methods, value engineering, regional partnerships,
transparency, stakeholder engagement, strategic investments, aging infrastructure,
repurposing of existing facilities, and competing financial priorities.
3. Social - Experience working and delivering projects, programs, and/or initiatives
that support Equity, Diversity, and Inclusion throughout your firm’s workplace,
including leadership, and supply chain. Examples of this may be demonstration of
working within cultural and language gaps, development of diversity programs,
diverse project teams, equitable opportunity Consultant supply chain, and how your
firm has applied an equity lens to processes such as recruitment, hiring, purchasing,
career pathways, salaries, and staff engagement.
Each element of the TBL sustainability criteria will receive equal consideration in
determining the final Sustainability/TBL score.
H. Cost and Work Hours
Reasonable preapproved expenses will be reimbursable per the current rates found at
www.gsa.gov. Consultant will be required to provide original receipts to the City for all
reimbursable expenses.
In your response to this proposal, please provide the following:
1. Estimated Hours by Task: Provide estimated hours for each proposed task by job
title and employee name, including the time required for meetings, conference calls,
etc.
2. Cost by Task: Provide the cost of each task identified in the Scope of Proposal
section. Provide a total not to exceed figure for the Scope of Proposal. Price all
additional services/deliverables separately.
3. Schedule of Rates: Provide a schedule of billing rates by category of employee and
job title to be used during the term of the Agreement. This fee schedule will be firm
for at least one (1) year from the date of the Agreement. The fee schedule will be
used as a basis for determining fees should additional services be necessary.
Include a per meeting rate in the event additional meetings are needed. A fee
schedule for sub-consultants, if used, shall be included.
4. All direct costs (i.e., travel, printing, postage, etc.) specifically attributed to the project
and not included in the billing rates must be identified. Reasonable preapproved
expenses will be reimbursable per the current rates found at www.gsa.gov.
Consultant will be required to provide original receipts to the City for all travel
expenses.
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I. Additional Information
Provide any information that distinguishes Consultant from its competition and any
additional information applicable to this RFP that might be valuable in assessing
Consultant’s proposal.
Explain any concerns Consultant may have in maintaining objectivity in recommending
the best solution. All potential conflicts of interest must be disclosed.
Exceptions to the Scope of Services and City Agreement (a sample of which is
attached in Section X) shall be documented.
VIII. REVIEW AND ASSESSMENT CRITERIA
A. Proposal and Interview Criteria
Consultants will be evaluated on the following criteria. These criteria will be the basis for
review and assessment of the written proposals and optional interview session. At the
discretion of the City, interviews of the top-rated Consultants may be conducted.
The rating scale shall be from 1 to 5, with 1 being a poor rating, 3 being an average rating,
and 5 being an outstanding rating.
WEIGHTING
FACTOR QUALIFICATION STANDARD
2.0 Scope of Proposal
Does the proposal address all elements of the
RFP? Does the proposal show an
understanding of the project objectives,
methodology to be used and results/outcomes
required by the project? Are there any
exceptions to the specifications, Scope of Work,
or agreement? Does the proposal provide
examples of innovative engagement
techniques? Can the work be completed in the
necessary time? Can the target start and
completion dates be met? Are other qualified
personnel available to assist in meeting the
project schedule if required?
2.0 Firm Capability
Does the firm have the resources, capacity and
support capabilities required to successfully
complete the project on-time and in-budget?
Has the firm successfully completed previous
projects of this type and scope?
2.0 Assigned Personnel
Do the persons who will be working on the
project have the necessary skills and
qualifications? Are sufficient people of the
requisite skills and qualifications assigned to the
project?
1.5 Availability
Can the work be completed in the necessary
time? Can the target start and completion dates
be met? Are other qualified personnel available
to assist in meeting the project schedule if
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required? Is the project team available to attend
meetings as required by the Scope of Work?
1.0 Sustainability/TBL
Methodology
Does the firm demonstrate a commitment to
Sustainability and incorporate Triple Bottom Line
methodology in both their Scope of Work for the
project, and their day-to-day business operating
processes and procedures?
2.0 Cost & Work Hours
Does the proposal included detailed cost break-
down for each cost element as applicable and
are the line-item costs competitive? Do the
proposed cost and work hours compare
favorably with the Project Manager's estimate?
Are the work hours presented reasonable for the
effort required by each project task or phase?
Definitions
Sustainable Purchasing is a process for selecting products or services that have a lesser
or reduced negative effect on human health and the environment when compared with
competing products or services that serve the same purpose. This process is also known
as “Environmentally Preferable Purchasing” (EPP), or “Green Purchasing”.
The Triple Bottom Line (TBL) is an accounting framework that incorporates three
dimensions of performance: economic, or financial; environmental, and social. The
generally accepted definition for TBL is that it “captures the essence of sustainability by
measuring the impact of an organization’s activities on the world…including both its
profitability and shareholders values and its social, human, and environmental capital.”
B. Reference Evaluation Criteria
Prior to award, the Project Manager will check references using the following criteria.
Negative responses from references may impact the award determination.
CRITERIA STANDARD QUESTIONS
Overall Performance Would you hire this Consultant again? Did they
show the skills required by this project?
Timetable
Was the original Scope of Work completed within the
specified time? Were interim deadlines met in a
timely manner?
Completeness
Was the Consultant responsive to client needs; did
the Consultant anticipate problems? Were problems
solved quickly and effectively?
Budget Was the original Scope of Work completed within the
project budget?
Job Knowledge
If a study, did it meet the Scope of Work?
If Consultant administered a construction contract,
was the project functional upon completion and did it
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operate properly? Were problems corrected quickly
and effectively?
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IX. CONSULTANT STATEMENT
Consultant hereby acknowledges receipt of the City of Fort Collins Request for Proposal and
acknowledges that it has read and agrees to be fully bound by all of the terms, conditions and
other provisions set forth in the RFP. Additionally, Consultant hereby makes the following
representations to City:
a. All of the statements and representations made in this proposal are true to the best of the
Consultant’s knowledge and belief.
b. Consultant commits that it is able to meet the terms provided in this proposal.
c. This proposal is a firm and binding offer, for a period of 90 days from the date hereof.
d. Consultant further agrees that the method of award is acceptable.
e. Consultant also agrees to complete the proposed Agreement with the City of Fort Collins
within 30 days of notice of award. If contract is not completed and signed within 30 days,
City reserves the right to cancel and award to the next highest rated firm.
f. Consultant acknowledge receipt of addenda.
Legal Firm Name:
Physical Address:
Remit to Address:
Phone:
Name of Authorized Agent of Firm:
Signature of Authorized Agent:
Primary Contact for Project:
Title: Email Address:
Phone: Cell Phone:
NOTE: CONSULTANT STATEMENT IS TO BE SIGNED & RETURNED WITH YOUR
PROPOSAL.
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X. SAMPLE AGREEMENT (FOR REFERENCE ONLY – DO NOT SIGN )
SERVICES AGREEMENT
THIS AGREEMENT made and entered into the day and year set forth below by and
between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter
referred to as the "City" and , hereinafter referred to as "Service Provider".
WITNESSETH:
In consideration of the mutual covenants and obligations herein expressed, it is agreed by
and between the parties hereto as follows:
1. Scope of Services. The Service Provider agrees to provide services in accordance with the
scope of services attached hereto as Exhibit A, consisting of ( ) page(s) and
incorporated herein by this reference. Irrespective of references in Exhibit A to certain
named third parties, Service Provider shall be solely responsible for performance of all
duties hereunder.
2. The Work Schedule. [Optional] The services to be performed pursuant to this Agreement
shall be performed in accordance with the Work Schedule attached hereto as Exhibit ,
consisting of ( ) page(s), and incorporated herein by this reference.
3. Time of Commencement and Completion of Services. The services to be performed
pursuant to this Agreement shall be initiated within ( ) days following execution
of this Agreement. Services shall be completed no later than . Time is of the essence.
Any extensions of the time limit set forth above must be agreed upon in a writing signed by
the parties.
4. Contract Period. This Agreement shall commence , 20 , and shall continue in
full force and effect until , 20 , unless sooner terminated as herein provided. In
addition, at the option of the City, the Agreement may be extended for additional one year
periods not to exceed ( ) additional one year periods. Renewals and pricing
changes shall be negotiated by and agreed to by both parties. Written notice of renewal
shall be provided to the Service Provider and mailed no later than thirty (30) days prior to
contract end.
5. Delay. If either party is prevented in whole or in part from performing its obligations by
unforeseeable causes beyond its reasonable control and without its fault or negligence, then
the party so prevented shall be excused from whatever performance is prevented by such
cause. To the extent that the performance is actually prevented, the Service Provider must
provide written notice to the City of such condition within fifteen (15) days from the onset of
such condition.
6. Early Termination by City/Notice. Notwithstanding the time periods contained herein, the
City may terminate this Agreement at any time without cause by providing written notice of
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termination to the Service Provider. Such notice shall be delivered at least fifteen (15) days
prior to the termination date contained in said notice unless otherwise agreed in writing by
the parties. All notices provided under this Agreement shall be effective when mailed,
postage prepaid and sent to the following addresses:
Service Provider: City: Copy to:
Attn:
City of Fort Collins
Attn:
PO Box 580
Fort Collins, CO 80522
City of Fort Collins
Attn: Purchasing Dept.
PO Box 580
Fort Collins, CO 80522
In the event of early termination by the City, the Service Provider shall be paid for services
rendered to the date of termination, subject only to the satisfactory performance of the
Service Provider's obligations under this Agreement. Such payment shall be the Service
Provider's sole right and remedy for such termination.
7. Contract Sum. The City shall pay the Service Provider for the performance of this Contract,
subject to additions and deletions provided herein, per the attached Exhibit ,
consisting of ( ) page(s), and incorporated herein by this reference.
8. City Representative. The City will designate, prior to commencement of the work, its
representative who shall make, within the scope of his or her authority, all necessary and
proper decisions with reference to the services provided under this agreement. All requests
concerning this agreement shall be directed to the City Representative.
9. Independent Service Provider. The services to be performed by Service Provider are those
of an independent service provider and not of an employee of the City of Fort Collins. The
City shall not be responsible for withholding any portion of Service Provider's compensation
hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or
for any other purpose.
10. Subcontractors. Service Provider may not subcontract any of the Work set forth in the
Exhibit A, Statement of Work without the prior written consent of the city, which shall not be
unreasonably withheld. If any of the Work is subcontracted hereunder (with the consent of
the City), then the following provisions shall apply: (a) the subcontractor must be a reputable,
qualified firm with an established record of successful performance in its respective trade
performing identical or substantially similar work, (b) the subcontractor will be required to
comply with all applicable terms of this Agreement, (c) the subcontract will not create any
contractual relationship between any such subcontractor and the City, nor will it obligate the
City to pay or see to the payment of any subcontractor, and (d) the work of the subcontractor
will be subject to inspection by the City to the same extent as the work of the Service
Provider.
11. Personal Services. It is understood that the City enters into the Agreement based on the
special abilities of the Service Provider and that this Agreement shall be considered as an
agreement for personal services. Accordingly, the Service Provider shall neither assign any
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responsibilities nor delegate any duties arising under the Agreement without the prior written
consent of the City.
12. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of the
services shall not be construed to operate as a waiver of any rights or benefits provided to
the City under this Agreement or cause of action arising out of performance of this
Agreement.
13. Warranty.
a. Service Provider warrants that all work performed hereunder shall be performed with the
highest degree of competence and care in accordance with accepted standards for work
of a similar nature.
b. Unless otherwise provided in the Agreement, all materials and equipment incorporated
into any work shall be new and, where not specified, of the most suitable grade of their
respective kinds for their intended use, and all workmanship shall be acceptable to City.
c. Service Provider warrants all equipment, materials, labor and other work, provided under
this Agreement, except City-furnished materials, equipment and labor, against defects
and nonconformances in design, materials and workmanship/workwomanship for a
period beginning with the start of the work and ending twelve (12) months from and after
final acceptance under the Agreement, regardless whether the same were furnished or
performed by Service Provider or by any of its subcontractors of any tier. Upon receipt
of written notice from City of any such defect or nonconformances, the affected item or
part thereof shall be redesigned, repaired or replaced by Service Provider in a manner
and at a time acceptable to City.
14. Default. Each and every term and condition hereof shall be deemed to be a material element
of this Agreement. In the event either party should fail or refuse to perform according to the
terms of this agreement, such party may be declared in default thereof.
15. Remedies. In the event a party has been declared in default, such defaulting party shall be
allowed a period of ten (10) days within which to cure said default. In the event the default
remains uncorrected, the party declaring default may elect to (a) terminate the Agreement
and seek damages; (b) treat the Agreement as continuing and require specific performance;
or (c) avail himself of any other remedy at law or equity. If the non-defaulting party
commences legal or equitable actions against the defaulting party, the defaulting party shall
be liable to the non-defaulting party for the non-defaulting party's reasonable attorney fees
and costs incurred because of the default.
16. Binding Effect. This writing, together with the exhibits hereto, constitutes the entire
agreement between the parties and shall be binding upon said parties, their officers,
employees, agents and assigns and shall inure to the benefit of the respective survivors,
heirs, personal representatives, successors and assigns of said parties.
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17. Indemnity/Insurance.
a. The Service Provider agrees to indemnify and save harmless the City, its officers, agents
and employees against and from any and all actions, suits, claims, demands or liability
of any character whatsoever brought or asserted for injuries to or death of any person
or persons, or damages to property arising out of, result from or occurring in connection
with the performance of any service hereunder.
b. The Service Provider shall take all necessary precautions in performing the work
hereunder to prevent injury to persons and property.
c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider
shall provide and maintain insurance coverage naming the City as an additional insured
under this Agreement of the type and with the limits specified within Exhibit ,
consisting of one (1) page, attached hereto and incorporated herein by this reference.
The Service Provider before commencing services hereunder, shall deliver to the City's
Purchasing Director, P. O. Box 580 Fort Collins, Colorado 80522 one copy of a
certificate evidencing the insurance coverage required from an insurance company
acceptable to the City.
18. Entire Agreement. This Agreement, along with all Exhibits and other documents
incorporated herein, shall constitute the entire Agreement of the parties. Covenants or
representations not contained in this Agreement shall not be binding on the parties.
19. Law/Severability. The laws of the State of Colorado shall govern the construction
interpretation, execution and enforcement of this Agreement. In the event any provision of
this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction,
such holding shall not invalidate or render unenforceable any other provision of this
Agreement.
20. Prohibition Against Unlawful Discrimination. The City of Fort Collins, in accordance with the
provisions of Title VI of the Civil Rights Act of 1964 (78 Stat. 252, 42 US.C. §§ 2000d to
2000d-4) and the Regulations, hereby notifies all bidders that it will affirmatively ensure that
any contract entered into pursuant to this advertisement, disadvantaged business
enterprises will be afforded full and fair opportunity to submit bids in response to this
invitation and will not be discriminated against on the grounds of race, color, or national
origin in consideration for an award.
The City strictly prohibits unlawful discrimination based on an individual’s gender
(regardless of gender identity or gender expression), race, color, religion, creed, national
origin, ancestry, age 40 years or older, marital status, disability, sexual orientation, genetic
information, or other characteristics protected by law. For the purpose of this policy “sexual
orientation” means a person’s actual or perceived orientation toward heterosexuality,
homosexuality, and bisexuality. The City also strictly prohibits unlawful harassment in the
workplace, including sexual harassment. Further, the City strictly prohibits unlawful
retaliation against a person who engages in protected activity. Protected activity includes
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an employee complaining that he or she has been discriminated against in violation of the
above policy or participating in an employment discrimination proceeding.
The City requires its vendors to comply with the City’s policy for equal employment
opportunity and to prohibit unlawful discrimination, harassment and retaliation. This
requirement applies to all third-party vendors and their subcontractors at every tier.
21. Prohibition Against Employing Illegal Aliens. Pursuant to Section 8-17.5-101, C.R.S., et.
seq., Service Provider represents and agrees that:
a. As of the date of this Agreement:
1. Service Provider does not knowingly employ or contract with an illegal alien who will
perform work under this Agreement; and
2. Service Provider will participate in either the e-Verify program created in Public Law
208, 104th Congress, as amended, and expanded in Public Law 156, 108th
Congress, as amended, administered by the United States Department of Homeland
Security (the “e-Verify Program”) or the Department Program (the “Department
Program”), an employment verification program established pursuant to Section 8-
17.5-102(5)(c) C.R.S. in order to confirm the employment eligibility of all newly hired
employees to perform work under this Agreement.
b. Service Provider shall not knowingly employ or contract with an illegal alien to perform
work under this Agreement or knowingly enter into a contract with a subcontractor that
knowingly employs or contracts with an illegal alien to perform work under this
Agreement.
c. Service Provider is prohibited from using the e-Verify Program or Department Program
procedures to undertake pre-employment screening of job applicants while this
Agreement is being performed.
d. If Service Provider obtains actual knowledge that a subcontractor performing work under
this Agreement knowingly employs or contracts with an illegal alien, Service Provider
shall:
1. Notify such subcontractor and the City within three days that Service Provider has
actual knowledge that the subcontractor is employing or contracting with an illegal
alien; and
2. Terminate the subcontract with the subcontractor if within three days of receiving the
notice required pursuant to this section the subcontractor does not cease employing
or contracting with the illegal alien; except that Service Provider shall not terminate
the contract with the subcontractor if during such three days the subcontractor
provides information to establish that the subcontractor has not knowingly employed
or contracted with an illegal alien.
e. Service Provider shall comply with any reasonable request by the Colorado Department
of Labor and Employment (the “Department”) made in the course of an investigation that
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the Department undertakes or is undertaking pursuant to the authority established in
Subsection 8-17.5-102 (5), C.R.S.
f. If Service Provider violates any provision of this Agreement pertaining to the duties
imposed by Subsection 8-17.5-102, C.R.S. the City may terminate this Agreement. If
this Agreement is so terminated, Service Provider shall be liable for actual and
consequential damages to the City arising out of Service Provider’s violation of
Subsection 8-17.5-102, C.R.S.
g. The City will notify the Office of the Secretary of State if Service Provider violates this
provision of this Agreement and the City terminates the Agreement for such breach.
22. Special Provisions. Special provisions or conditions relating to the services to be performed
pursuant to this Agreement are set forth in Exhibit - Confidentiality, consisting of three
(3) pages, as well as Exhibit - Federal Terms and Conditions for Community
Development Block Grant Funding, consisting of eight (8) pages, attached hereto and
incorporated herein by this reference.
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THE CITY OF FORT COLLINS, COLORADO
By:
Gerry Paul
Purchasing Director
DATE:
ATTEST:
APPROVED AS TO FORM:
SERVICE PROVIDER'S NAME
By:
Printed:
Title:
CORPORATE PRESIDENT OR VICE PRESIDENT
Date:
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EXHIBIT A
SCOPE OF SERVICES
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EXHIBIT
(BID SCHEDULE/COMPENSATION)
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EXHIBIT
INSURANCE REQUIREMENTS
1. The Service Provider will provide, from insurance companies acceptable to the City, the
insurance coverage designated hereinafter and pay all costs. Before commencing work
under this bid, the Service Provider shall furnish the City with certificates of insurance
showing the type, amount, class of operations covered, effective dates and date of
expiration of policies, and containing substantially the following statement:
“The insurance evidenced by this Certificate will not reduce coverage or limits and
will not be cancelled, except after thirty (30) days written notice has been received
by the City of Fort Collins.”
In case of the breach of any provision of the Insurance Requirements, the City, at its
option, may take out and maintain, at the expense of the Service Provider, such
insurance as the City may deem proper and may deduct the cost of such insurance from
any monies which may be due or become due the Service Provider under this
Agreement. The City, its officers, agents and employees shall be named as additional
insureds on the Service Provider 's general liability and automobile liability insurance
policies for any claims arising out of work performed under this Agreement.
2. Insurance coverages shall be as follows:
A. Workers' Compensation & Employer's Liability. The Service Provider shall
maintain during the life of this Agreement for all of the Service Provider's
employees engaged in work performed under this agreement:
1. Workers' Compensation insurance with statutory limits as required by
Colorado law.
2. Employer's Liability insurance with limits of $100,000 per accident,
$500,000 disease aggregate, and $100,000 disease each employee.
B. Commercial General & Vehicle Liability. The Service Provider shall maintain
during the life of this Agreement such commercial general liability and automobile
liability insurance as will provide coverage for damage claims of personal injury,
including accidental death, as well as for claims for property damage, which may
arise directly or indirectly from the performance of work under this Agreement.
Coverage for property damage shall be on a "broad form" basis. The amount of
insurance for each coverage, Commercial General and Vehicle, shall not be less
than $1,000,000 combined single limits for bodily injury and property damage.
In the event any work is performed by a subcontractor, the Service Provider shall
be responsible for any liability directly or indirectly arising out of the work
performed under this Agreement by a subcontractor, which liability is not covered
by the subcontractor's insurance.
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EXHIBIT
CONFIDENTIALITY
IN CONNECTION WITH THE SERVICES to be provided by Professional under this
Agreement, the parties agree to comply with reasonable policies and procedures with regard to
the exchange and handling of confidential information and other sensitive materials between the
parties, as set forth below.
1. Definitions.
For purposes of this Agreement, the party who owns the confidential information and is
disclosing same shall be referenced as the “Disclosing Party.” The party receiving the
Disclosing Party’s confidential information shall be referenced as the “Receiving Party.”
2. Confidential Information.
Confidential Information controlled by this Agreement refers to information which is not
public and/or is proprietary and includes by way of example, but without limitation, City
customer information, utility data, service billing records, customer equipment information,
location information, network security system, business plans, formulae, processes,
intellectual property, trade secrets, designs, photographs, plans, drawings, schematics,
methods, specifications, samples, reports, mechanical and electronic design drawings,
customer lists, financial information, studies, findings, inventions, and ideas.
To the extent practical, Confidential Information shall be marked “Confidential” or
“Proprietary.” Nevertheless, Professional shall treat as Confidential Information all customer
identifiable information in any form, whether or not bearing a mark of confidentiality or
otherwise requested by the City, including but not limited to account, address, billing,
consumption, contact and other customer data. In the case of disclosure in non-
documentary form of non-customer identifiable information, made orally or by visual
inspection, the Disclosing Party shall have the right, or, if requested by the Receiving Party,
the obligation to confirm in writing the fact and general nature of each disclosure within a
reasonable time after it is made in order that it is treated as Confidential Information. Any
information disclosed to the other party prior to the execution of this Agreement and related
to the services for which Professional has been engaged shall be considered in the same
manner and be subject to the same treatment as the information disclosed after the
execution of this Agreement with regard to protecting it as Confidential Information.
3. Use of Confidential Information.
Receiving Party hereby agrees that it shall use the Confidential Information solely for the
purpose of performing its obligations under this Agreement and not in any way detrimental
to Disclosing Party. Receiving Party agrees to use the same degree of care Receiving Party
uses with respect to its own proprietary or confidential information, which in any event shall
result in a reasonable standard of care to prevent unauthorized use or disclosure of the
Confidential Information. Except as otherwise provided herein, Receiving Party shall keep
confidential and not disclose the Confidential Information. The City and Professional shall
cause each of their directors, officers, employees, agents, representatives, and
subcontractors to become familiar with, and abide by, the terms of this section, which shall
survive this Agreement as an on-going obligation of the Parties.
Professional shall not use such information to obtain any economic or other benefit for itself,
or any third party, other than in the performance of obligations under this Agreement.
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4. Exclusions from Definition.
The term “Confidential Information” as used herein does not include any data or information
which is already known to the Receiving Party or which before being divulged by the
Disclosing Party (1) was generally known to the public through no wrongful act of the
Receiving Party; (2) has been rightfully received by the Receiving Party from a third party
without restriction on disclosure and without, to the knowledge of the Receiving Party, a
breach of an obligation of confidentiality; (3) has been approved for release by a written
authorization by the other party hereto; or (4) has been disclosed pursuant to a requirement
of a governmental agency or by operation of law.
5. Required Disclosure.
If the Receiving Party is required (by interrogatories, requests for information or documents,
subpoena, civil investigative demand or similar process, or by federal, state, or local law,
including without limitation, the Colorado Open Records Act) to disclose any Confidential
Information, the Parties agree the Receiving Party will provide the Disclosing Party with
prompt notice of such request, so the Disclosing Party may seek an appropriate protective
order or waive the Receiving Party’s compliance with this Agreement.
The Receiving Party shall furnish a copy of this Agreement with any disclosure.
6. Notwithstanding paragraph 5, Professional shall not disclose Confidential Information to any
person, directly or indirectly, nor use it in any way, except as required or authorized in
writing by the City.
7. Red Flags Rules.
Professional must implement reasonable policies and procedures to detect, prevent and
mitigate the risk of identity theft in compliance with the Identity Theft Red Flags Rules found
at 16 Code of Federal Regulations part 681. Further, Professional must take appropriate
steps to mitigate identity theft if it occurs with one or more of the City’s covered accounts
and must as expeditiously as possible notify the City in writing of significant breeches of
security or Red Flags to the City.
8. Data Protection and Data Security.
In addition to the requirements of paragraph 7, Professional shall have in place information
security safeguards designed to conform to or exceed industry best practices regarding the
protection of the confidentiality, integrity and availability of utility and customer information
and shall have written agreements requiring any subcontractor to meet those standards.
These information security safeguards (the “Information Security Program”) shall be
materially consistent with, or more stringent than, the safeguards described in this Exhibit.
a) Professional’s information security safeguards shall address the following elements:
• Data Storage, Backups and Disposal
• Logical Access Control (e.g., Role-Based)
• Information Classification and Handling
• Secure Data Transfer (SFTP and Data Transfer Specification)
• Secure Web Communications
• Network and Security Monitoring
• Application Development Security
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• Application Security Controls and Procedures (User Authentication, Security
Controls, and Security Procedures, Policies and Logging)
• Incident Response
• Vulnerability Assessments
• Hosted Services
• Personnel Security
b) Subcontractors. Professional may use subcontractors, though such activity shall not
release or absolve Professional from the obligation to satisfy all conditions of this
Agreement, including the data security measures described in this Exhibit, and to require
a substantially similar level of data security, appropriate to the types of services provided
and Customer Data received, for any subcontractor Professional may use. Accordingly,
any release of data, confidential information, or failure to protect information under this
Agreement by a subcontractor or affiliated party shall be attributed to Professional and
may be considered to be a material breach of this Agreement.
9. Confidential Information is not to be stored on any local workstation, laptop, or media such
as CD/DVD, USB drives, external hard drives or other similar portable devices unless the
Professional can ensure security for the Confidential Information so stored. Work stations or
laptops to be used in the Work will be required to have personal firewalls on each, as well as
have current, active anti-virus definitions.
10. The Agreement not to disclose Confidential Information as set forth in this Exhibit shall apply
during the term of the Work and at any time thereafter unless specifically authorized by the
City in writing.
11. If Professional breaches this Agreement, in the City’s sole discretion, the City may
immediately terminate this Agreement and withdraw Professional’s right to access
Confidential Information.
12. Notwithstanding any other provision of this Agreement, all material, i.e., various physical
forms of media in which Confidential Information is contained, including but not limited to
writings, drawings, tapes, diskettes, prototypes or products, shall remain the sole property of
the Disclosing Party and, upon request, shall be promptly returned, together with all copies
thereof to the Disclosing Party. Upon such return of physical records, all digital and
electronic data shall also be deleted in a non-restorable way by which it is no longer
available to the Receiving Party. Written verification of the deletion (including date of
deletion) is to be provided to the Disclosing Party within ten (10) days after completion of
engagement, whether it be via termination, completion or otherwise.
13. Professional acknowledges that the City may, based upon the representations made in this
Agreement, disclose security information that is critical to the continued success of the City’s
business. Accordingly, Professional agrees that the City does not have an adequate remedy
at law for breach of this Agreement and therefore, the City shall be entitled, as a non-
exclusive remedy, and in addition to an action for damages, to seek and obtain an injunction
or decree of specific performance or any other remedy, from a court of competent
jurisdiction to enjoin or remedy any violation of this Agreement.
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EXHIBIT __
FEDERAL TERMS AND CONDITIONS FOR
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDING
SECTION 1. COMPLIANCE WITH LAWS.
(A) The Professional, in performance of this Agreement, agrees to comply with all
applicable Federal, State and Local Laws and ordinances, and the rules and regulations
promulgated by the U.S. Department of Housing and Urban Development, including but not
limited to the requirements of Title 24 Code of Federal Regulations, Part 570, of the Housing and
Urban Development regulations concerning Federal Community Development Block Grant
Regulations, Title II of the Cranston-Gonzales National Affordable Housing Act and all federal
regulations and policies issued pursuant to these regulations; and other policies and guidelines
established for the City of Fort Collins CDBG Program. Professional agrees to comply with all
provisions of the Americans with Disabilities Act and all regulations interpreting or enforcing such
act.
(B) The Professional shall carry out each activity in compliance with all Federal laws
and regulations described in Subpart K of 24 CFR 570 (Other Program Requirements), regardless
if the law is specifically stated in this Agreement, except that the Professional does not assume
the City’s environmental responsibilities described in Section 570.604; and the Professional does
not assume the City’s responsibility for initiating the review process under Executive Order 12372.
(C) The Professional agrees to comply with all applicable Federal, State, County or
Municipal standards for licensing, certification and operation of facilities and programs, and
accreditation and licensing of individuals, and any other standards or criteria as described in the
Agreement to assure quality of services; and the Professional agrees to obtain, at its own
expense, all necessary licenses and permits.
In the event of an investigation pertaining to, or a suspension of any license or permit related to
the services for which the City is providing funding under this Agreement, the City may
terminate this Agreement and withhold all further funds, and may require the Professional to
remit to the City all (or a portion of) the funds theretofore received under this Agreement. The
City may also declare the Professional ineligible for any further participation in City Community
Development Block Grant (CDBG), HOME Investment Partnership, Affordable Housing Fund
(AHF), Human Services Program (HSP), and/or Keep Fort Collins Great (KFCG) Agreements.
SECTION 2. FEDERAL STANDARDS FOR EMPLOYMENT PRACTICES
Professional shall comply with Executive Order 11246 as amended by Executive Order
12086 and the regulations issued pursuant thereto (41 CFR Chapter 60) will not discriminate
against any employee or applicant for employment because of race, color, creed, religion,
ancestry, national origin, sex, disability or other handicap, age, marital status, or status with
regard to public assistance. Professional will take affirmative action to ensure that all
employment practices are free from such discrimination. Such employment practices
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include but are not limited to the following: hiring, upgrading, demotion, transfer, recruitment
or recruitment advertising, layoff, termination, rates of pay or other forms of compensation
and selection for training, including apprenticeship.
Professional agrees to post in conspicuous places, available to employees and applicants
for employment, notices setting forth the provisions of this nondiscrimination clause.
Professional will, in all solicitations or advertisements for employees placed by or on behalf
of Professional, state that it is an Equal Opportunity or Affirmative Action Employer.
Where employees are engaged in activities not covered under the Occupational Safety
and Health Act (OSHA) of 1970, they shall not be required or permitted to work, be trained or
receive services in buildings or surroundings or under working conditions which are unsanitary,
hazardous or dangerous to the participants’ health or safety.
SECTION 3. LOCAL EMPLOYMENT AND PURCHASING
Funding under this agreement is subject to the requirements of Section 3 of the Housing
and Urban Development Act of 1968, as amended, 12 USC 1701u. Professional agrees to
comply with provisions of said Section 3 and the regulations issued pursuant thereto by the
Secretary of Housing and Urban Development set forth in 24 CFR Part 135, and all applicable
rules and orders of the Department of Housing and Urban Development issued thereunder.
Professional agrees that it is under no contractual or other disability which would prevent it from
complying with these requirements.
Section 3 requires that to the greatest extent feasible, opportunities for training and
employment be given to lower income residents of the project area and agreements for work in
connection with the project be awarded to business concerns which are located in or owned in
substantial part by persons residing in, the area of the project. Section 3 applies to training,
employment, contracting and other economic opportunities arising in connection with the
expenditure of housing assistance and community development assistance that is used for the
following projects: 1. Housing rehabilitation (including reduction and abatement of lead based
paint hazards, but excluding routine maintenance, repair and replacement); 2. Housing
construction; and 3. Other public construction.
SECTION 4. FEDERAL STANDARDS FOR MINORITY AND WOMEN-OWNED BUSINESS
ENTERPRISES
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Professional will use its best efforts to afford minority and women-owned business
enterprises the maximum practicable opportunity to participate in the performance of this
Agreement. As used in this Agreement, the term "minority and female business enterprise"
means a business at least fifty-one (51) percent owned and controlled by minority group
members or women. For the purpose of this definition, "minority group members" are Afro-
Americans, Spanish-speaking, Spanish surnamed or Spanish-heritage Americans, Asian-
Americans and American Indians. Professional may rely on written representations by its
subcontractors regarding their status as minority and female business enterprises in lieu of
an independent investigation.
SECTION 5. CONFLICT OF INTEREST
No member, officer, or employee of Professional, or its designees or agents, who
exercises any function or responsibilities with respect to the program during his tenure or for
one year thereafter, shall have any interest, direct or indirect, in this Agreement or any
Subagreement, hereto or the proceeds thereof. Any potential conflict on the part of any of these
parties shall be disclosed to representatives of the City’s CDBG Program or the City Attorney’s
Office.
SECTION 6 DAVIS BACON AND RELATED ACTS
Professional shall comply with the requirements of the Davis-Bacon and Related Acts
(DBRA) when the contract for construction, alteration, and/or repair exceeds $2,000, is federally
assisted, and involves the employment of laborers and/or mechanics to perform the work.
SECTION 7. DISCRIMINATION PROHIBITED
(A) Professional agrees to comply with Title VI of the Civil Rights Act of 1964 as
amended, Title VIII of the Civil Rights Act of 1968 as amended, Section 104(b) and Section 109
of Title I of the Housing and Community Development Act of 1974 as amended, Section 504 of
the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination
Act of 1975, Executive Order 11063, and Executive Order 11246 as amended by Executive
Orders 11375, 11478 and 12086.
Professional shall not, on the grounds of race, color, national origin, religion, creed, disability,
age, sex, actual or perceived sexual orientation, gender identity, marital status, or familial
status:
(1) Deny a qualified individual any facilities, financial aid, services or other benefits
provided under this Agreement;
(2) Provide any facilities, services, financial aid, or other benefits which are different,
or are provided in a different manner, from those provided to others under this
Agreement;
(3) Subject an individual to segregated or separate treatment in any facility in, or in
any matter if process related to receipt of any service or benefit under this
Agreement;
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(4) Restrict an individual in any way in access to, or in the enjoyment of any
advantage or privilege enjoyed by others in connection with any service or
benefit under this Agreement;
(5) Treat anyone differently from others in determining if they satisfy any admission,
enrollment, eligibility, membership or other requirement or condition which the
individual must meet to be provided a service or benefit under this Agreement;
(6) Deny anyone an opportunity to participate in any program or activity as an
employee that is different from that afforded others under this Agreement.
Professional shall:
(1) Develop and provide to the City in writing, a Title VI Plan describing how the
Professional will implement compliance with Title VI, and a Language Access
Plan, describing how the Professional will provide meaningful language access to
persons with limited English proficiency. Both Plans are subject to approval by
the City; and
(2) Post written notice of non-discrimination in its facilities and make available to its
clients a Title VI complaint form, in a form reasonably acceptable to the City.
(B) Professional shall abide by all applicable provisions of Section 504 of the HEW
Rehabilitation Act of 1973 as amended (implemented in 24 CFR part 8) prohibiting
discrimination against handicapped individuals, and the Age Discrimination Act of 1975
(implemented in 24 CFR part 146) prohibiting discrimination on the basis of age, either through
purpose or intent.
(C) If assignment and/or subcontracting has been authorized in writing, said
assignment or subcontract shall include appropriate safeguards against discrimination in client
services binding upon each contractor or subcontractor. Professional shall take such action as
may be required to ensure full compliance with the provisions of this section, including sanctions
for noncompliance.
(D) In providing services utilizing CDBG funds the Professional agrees that:
(1) It will not discriminate against any employee or applicant for employment on the
basis of religion and will not limit employment or give preference in employment
to persons on the basis of religion;
(2) It will not discriminate against any person applying for such public services on the
basis of religion and will not limit such services or give preference to persons on
the basis of religion;
(3) It will provide no mandatory religious instruction or counseling, conduct no
religious worship or services, engage in no religious proselytizing, and exert no
other religious influence in the provision of such services;
SECTION 8. BENEFIT TO LOW INCOME PEOPLE
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If Professional is providing direct benefit services, Professional shall provide such
services to benefit extremely low, very low, and low income persons to the maximum extent
feasible (but not less than 51%). Individual persons or families provided a specific direct benefit
or service must qualify under current income eligibility limits (% of AMI) as established by HUD.
Any deviation can be made only if it is clear that the service or benefit, to a person whose
income exceeds very low and low income persons, is otherwise necessary as an integral part of
the activity. The Professional shall maintain records that clearly document the income range
and household size of the persons it serves. Furthermore, the Professional shall maintain
records documenting if the person being served is a female or male head of household, is an
ethnic/racial minority, and/or has a disability.
SECTION 9. PROOF OF LAWFUL PRESENCE
Professional acknowledges that the City’s Competitive Process funds are a “public benefit”
within the meaning of C.R.S. § 24-76.5-102. As such, if the Professional is using the funds
received to provide a public benefit to individuals, the Professional shall ensure compliance
with C.R.S. § 24-76.5-103 of State statute by performing the required verifications. Specifically,
when required the Professional shall ensure that:
a. if the public benefit provided by the funds flows directly to a natural person (i.e.,
not a corporation, partnership, or other legally-created entity) 18 years of age or older, he/she
must do the following:
(i) complete an affidavit attached to this Agreement as a template, Attachment A.
(ii) attach a photocopy of the front and back of one of the following forms of
identification: a valid Colorado driver’s license or Colorado identification card; a
United States military card or military dependent’s identification card; a United
States Coast Guard Merchant Mariner identification card; or a Native American
tribal document.
b. If an individual applying for the benefits identified herein executes the affidavit
stating that he/she is an alien lawfully present in the United States, Professional shall verify
his/her lawful presence through the federal systematic alien verification or entitlement program,
known as the “SAVE Program,” operated by the U.S. Department of Homeland Security or a
successor program designated by said department. In the event Professional determines
through such verification process that the individual is not an alien lawfully present in the United
States, the Professional shall not provide benefits to such individual with the City’s Competitive
Process funds.
The City acknowledges that the Scope of Services provided by Professional herein may
fall within several exceptions to the verification requirements of C.R.S. § 24-76.5-103 for non-
profits. For example, certain programs, services, or assistance such as, but not limited to, soup
kitchens, crisis counseling and intervention, short-term shelter or prenatal care are not subject
to the verification requirements of C.R.S. § 24-76.5-103.
SECTION 10. CITIZEN AND CLIENT PARTICIPATION
If applicable to its scope of services, the professional will have processes in place
(satisfaction surveys, Board representation, grievance procedures, etc.) which receive,
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document and utilize the input from low-income persons potentially benefiting or affected by the
program or project covered under this Agreement.
SECTION 11. ARCHITECTURAL BARRIERS ACT/AMERICANS WITH DISABILITIES ACT
Professional shall meet the requirements, where applicable, of the Architectural Barriers
Act and the Americans with Disabilities Act, as set forth in 24 CFR 570.614. A building or facility
designed, constructed, or altered with funds allocated or reallocated under the CDBG program
after December 11, 1995 and that meets the definition of “residential structure” as defined in 24
CFR part 40.2 or the definition of “building” as defined in 41 CFR part 101-19.602(a) is subject
to the requirements of the Architectural Barriers Act of 1968 (42 USC 4151-4157) and shall
comply with the Uniform Federal Accessibility Standards (Appendix A to 24 CFR part 40 for
residential structures, and Appendix A to 41 CFR part 101-19, subpart 101-19.6, for general
type buildings). The Americans with Disabilities Act (“ADA”) (42 USC 12131; 47 USC 155, 210,
218 and 255) requires that the design and construction of facilities for first occupancy after
January 26, 1993 must include measures to make them readily accessible and usable by
individuals with disabilities. The ADA further requires the removal of architectural barriers and
communication barriers that are structural in nature in existing facilities, where such removal is
readily achievable--that is, easily accomplishable and able to be carried out without much
difficulty or expense.
SECTION 12. LEAD BASED PAINT
Professional shall comply with HUD Lead-Based Paint Regulations (24 CFR Part 35 et
seq.) issued in the Federal Register, September 15, 1999, which require elimination, as far as
practical, of immediate hazards due to the presence of paint in residential structures that may
contain lead to which children under seven years of age may be exposed.
SECTION 13. DOCUMENTATION OF COSTS AND OTHER FINANCIAL REPORTING
(A) All costs shall be supported by properly executed payrolls, time records, invoices,
vouchers or other official documentation, as evidence of the nature and propriety of the charges.
All accounting documents pertaining in whole or in part to this Agreement shall be clearly
identified and readily accessible, and upon reasonable notice, the City and United States
Department of Housing and Urban Development shall have the right to audit the records of the
Professional as they relate to the work. The Professional shall also:
(1) Maintain an effective system of internal fiscal control and accountability for all
CDBG funds and property acquired or improved with CDBG funds, and make
sure the same are used solely for authorized purposes.
(2) Keep a continuing record of all disbursements by date, check number, amount,
vendor, description of items purchased and line item from which money was
expended, as reflected in the Professional’s accounting records. The line item
notations must be substantiated by a receipt, invoice marked “Paid,” or payroll
record.
(3) Maintain payroll, financial, and expense reimbursement records for a period of
five (5) years after receipt of final payment under this Agreement.
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(4) Permit inspection and audit of its records with respect to all matters authorized by
this Agreement by representatives of the City, the State Auditor or the United
States Department of Housing and Urban Development at any time during
normal business hours and as often as necessary.
(5) Inform the City concerning any funds allocated to the Professional that the
Professional anticipates will not be expended during the Agreement period, and
permit reassignment of the same by the City to other subrecipients.
(6) Repay to the City any funds in its possession at the time of termination of this
Agreement that may be due to the City or the United States Department of
Housing and Urban Development.
(7) Maintain complete records concerning the receipt and use of all program income.
Program income shall be reported on a monthly basis on forms provided by the
City.
(8) By executing this Contract, Professional verifies and affirms that it has not been
suspended or debarred from participating in or receiving federal government
contracts, subcontracts, loans, grants or other assistance programs.
(B) In the event the City or United States Department of Housing and Urban
Development determines any funds were expended by the Professional for unauthorized or
ineligible purposes or the expenditures constitute disallowed costs in any other way, the City or
United States Department of Housing and Urban Development may order repayment of the
same. The Professional shall remit the disallowed amount to the City within thirty (30) days of
written notification of the disallowance.
(1) The Professional agrees that funds determined by the City to be surplus upon
completion of the Agreement will be subject to cancellation by the City.
(2) The City shall be relieved of any obligation for payments if funds allocated to the
City cease to be available for any cause other than misfeasance of the City itself.
(3) The City reserves the right to withhold payments pending timely delivery of
program reports or documents as may be required under this Agreement.
SECTION 14. DISPLACEMENT, RELOCATION, ACQUISITION AND REPLACEMENT OF
HOUSING
If applicable, the Professional shall comply with the requirements relating to
displacement, relocation, acquisition and replacement of housing (24 CFR Part 570.606).
Displacement of persons (families, individuals, businesses, non-profit organizations and farms)
as a result of activities assisted with CDBG funds is generally discouraged.
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ATTACHMENT A
AFFIDAVIT TEMPLATE FOR PROOF OF LEGAL PRESENCE
AFFIDAVIT PURSUANT TO C.R.S.24-76.5-103
I, _____________________________________, swear or affirm under penalty of perjury
under the laws of the State of Colorado that (check one):
_____ I am a United States citizen, or
_____ I am a Permanent Resident of the United States, or
_____ I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I have applied for a
public benefit. I understand that state law requires me to provide proof that I am lawfully present
in the United States prior to receipt of this public benefit. I further acknowledge that making a
false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable
under the criminal laws of Colorado as perjury in the second degree under Colorado Revised
Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is
fraudulently received.
____________________________________ ___________________________
Signature Date
INTERNAL USE ONLY: Valid Forms of Identification
• current Colorado driver’s license, minor driver’s license, probationary driver’s license, commercial driver’s license,
restricted driver’s license, instruction permit
• current Colorado identification card
• U.S. military card or dependent identification card
• U.S. coast guard merchant mariner card
• Native American tribal document