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HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA)
REQUEST FOR PROPOSALS
AND
APPLICATION
2009
State of New York
David A. Paterson
Governor
NEW YORK STATE
OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE
David A. Hansell
Commissioner
NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE
BUREAU OF HOUSING AND SHELTER SERVICES (BHSS)
2009 REQUEST FOR PROPOSALS
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA)
TABLE OF CONTENTS
PAGE NUMBER
I INTRODUCTION 1
II PROCUREMENT SCHEDULE 3
III PROGRAM DESCRIPTION/ ELIGIBLE ACTIVITIES 3
IV ELIGIBLE APPLICANTS 8
V ELIGIBLE SERVICES AND COSTS 9
VI INELIGIBLE SERVICES AND COSTS 9
VII ELIGIBLE POPULATION 9
VIII LOCAL APPROVAL 10
IX MAINTENANCE OF EFFORT 10
X SELECTION PROCESS 10
XI HOW TO APPLY 13
XII AWARD PROCEDURES 13
XIII REPORTS AND RECORD KEEPING 14
XIV GENERAL TERMS AND CONDITIONS 15
XV APPLICATION GUIDELINES 23
A APPLICANT INFORMATION FORM 26
B DOCUMENTATION OF NEED 30
C PROGRAM PLAN 31
D AGENCY INFORMATION 33
E BUDGET STATEMENT 47
F BUDGET EXPENSE DETAILS 48
G APPLICATION CHECKLIST 55
H DOCUMENTATION OF CONTINUING FINANCIAL SUPPORT 57
I FEDERAL CERTIFICATIONS 58
J CERTIFICATION OF LOCAL APPROVAL 60
Attachment A 24 CFR PART 574 (HOPWA REGULATIONS)
NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE
Bureau of Housing and Shelter Services (BHSS)
2009 REQUEST FOR PROPOSALS
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA)
I. INTRODUCTION
The New York State Office of Temporary and Disability Assistance (hereinafter "OTDA")
announces a funding opportunity for the Housing Opportunities for Persons with AIDS
(HOPWA) program. The OTDA is requesting proposals from charitable corporations, not-for-
profit organizations and public housing agencies for funding to provide housing and related
support services to low-income persons with AIDS or HIV-related illnesses and their families.
This RFP is issued pursuant to 24 Code of Federal Regulations (CFR) Part 574, entitled
Housing Opportunities for Persons with AIDS (see Attachment A). The U.S. Department of
Housing and Urban Development (HUD) allocates approximately $1.8 million in HOPWA
funding to New York State annually. Funding of contracts under this RFP is contingent upon
actual availability of Federal HOPWA funds. Contracts awarded under HOPWA are 100%
federally funded and HOPWA has a catalog of federal assistance (CFDA) number of 14.241.
While applicants may request funds through this New York State RFP for a number of different
activities, priority will be given to proposals that will result in the continued or expanded
availability of housing units and critical support services for persons with HIV/AIDS. Potential
applicants should carefully review the attached HOPWA regulations before drafting their
application in order to assure consistency with the regulations.
NYS OTDA has given funding priority to the development of long-term and short-term rental
assistance and supportive services under this RFP.
Funding under this RFP is reserved for applications to serve areas of the State that do not
receive direct HOPWA allocations from HUD. Our goal is to reach geographic areas where
persons with HIV/AIDS are underserved and fill the housing and support services gaps that
cannot be funded through other sources. (Please see Section IV – Eligible Applicants.)
Because of the limited HOPWA funds available to New York State, applicants must demonstrate
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that funds are either not available from other sources to support the proposed activities or that
HOPWA dollars are required to supplement the proposed activities.
Agencies applying for continued HOPWA funding must demonstrate the direct, positive
impact their program has had on the availability of housing and support services.
Applicants interested in applying for HOPWA funds should follow the directions in this Request
for Proposals (RFP). All proposals must be received by 3:00 p.m., Tuesday, July 14, 2009.
Any proposal received after the deadline will be reviewed solely at the discretion of OTDA.
If selected, the proposal or parts of it submitted in response to this RFP will become part of a
contract with OTDA subject to approval by the New York State Attorney General and the Office
of the State Comptroller. At the time of contract development, awardees will be required to
submit additional budget and program information for the contract.
Successful grantees must certify that they will abide by all applicable State and Federal laws,
regulations, and requirements, including the State’s HIV confidentiality laws.
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II. PROCUREMENT SCHEDULE
Request for Proposals Released: June 1, 2009
Proposal Due Date: July 14, 2009
Notification of Awards: September, 2009
Contract Start Date: January 1, 2010
Contract End Date: December 31, 2012
QUESTIONS AND ANSWERS ABOUT THIS RFP:
Any questions about this RFP must be submitted in writing by 5:00 P.M., June 17, 2009 to the
attention of Ms. Linda Camoin at the New York State Office of Temporary and Disability
Assistance, Bureau of Housing and Shelter Services, 40 North Pearl Street, Albany, New York
12243, or FAX (518) 486-7068, or e-mail to Linda.camoin@otda.state.ny.us.
All questions must be typed. Along with your question(s), provide your name, organization,
mailing address and fax number.
The written response to all questions will be posted on the OTDA website
(www.otda.state.ny.us). NYS Office of Temporary and Disability Assistance will not entertain
questions via telephone. Any question received after the specified deadline will be answered
and published in the Question and Answer document, at the discretion of OTDA.
III. PROGRAM DESCRIPTION/ELIGIBLE ACTIVITIES
All applicants receiving funds will be required, by contract, to comply with the Federal
regulations governing this program. These regulations are found at 24 CFR Part 574, published
as a Final Rule on April 11, 1994, and are attached to this RFP as Attachment A. OMB
Circulars 110 and 122, which apply to not-for-profit organizations receiving Federal funds and
who are applying for funding under this RFP, are available upon request and will be provided to
all successful applicants. The Federal regulations list several basic program activities that are
eligible for funding under HOPWA. While the State will accept applications to fund most of
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these activities, funding priority will be given to proposals that are likely to achieve the following
objectives:
Continue programs that have a demonstrated track record of success in providing eligible
services;
Result in the continuation or expansion of housing units available to low-income persons
with HIV/AIDS and their families;
Serve geographic areas in which persons with HIV/AIDS are underserved;
Fill gaps in the continuum of housing and support services that cannot be funded through
other Federal, State, local, and/or private sources; and,
Help to create an integrated, comprehensive approach to meeting the housing needs of
persons with HIV/AIDS within a given geographic area.
Based on these objectives, activities eligible for funding under OTDA’s HOPWA program have
been grouped into two categories.
Group 1 – High Priority Activities (See below for details and limitations)
a. Project-based or tenant-based rental assistance
b. Supportive services
c. Short-term payments for rent/mortgage/utility costs to prevent homelessness
Group 2 – Lower Priority Activities (See below for details and limitations)
d. Technical assistance
e. Operating costs for housing
f. Housing information and referral services to help individuals obtain housing
g. Lease or repair of facilities to provide housing and services
The State will not make use of its limited HOPWA funds for new construction,
acquisition, rehabilitation, or conversion of housing sites, even though these activities
are eligible under the Federal regulations. Funds for capital development activities are
available through the State’s Homeless Housing and Assistance Program (HHAP) and other
sources.
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Several of the activities listed above may involve the use of the following types of housing and
assistance, some of which must follow certain HUD guidelines and limitations on funding as well
as applicable New York State guidelines.
Community residences: Defined by HUD as a multi-unit residence designed for
eligible persons to provide a lower cost residential alternative to institutional care and
to provide a permanent or transitional residential setting with appropriate services.
Applicants proposing to use HOPWA funds for the operation of community residences
must comply with the HUD requirements listed in 24 CFR Section 574.340. (See
Attachment A.)
Single room occupancy (SRO) dwellings: HUD provides no specific guidelines for
SRO units. However, New York State requires SRO units assisted with HOPWA
funds to meet the minimum applicable State and/or local codes.
Short-term supported housing: Defined by HUD (24 CFR Section 574.330) to
include “facilities to provide temporary shelter.” Short-term supported housing may
not provide residence to any individual for more than 60 days during any six-month
period or house more than 50 families or individuals at a time. Short-term or
transitional housing generally is not considered a priority by New York State,
unless a compelling need for such housing can be demonstrated.
Other types of housing not listed above: HOPWA regulations do not restrict funded
activities to the types of housing listed above, although other types of housing may
not be deemed a priority by New York State.
The following are general guidelines and requirements for the activities that can be funded
under New York State’s HOPWA program.
Group 1 – High Priority Activities
a. Project-based or tenant-based rental assistance
Rental assistance programs under HOPWA must meet Federal and State
requirements regarding eligibility, rental payment structure, maximum subsidies,
and compliance with HUD Housing Quality Standards, etc. Applicants must
demonstrate that funds to assist eligible persons with rental costs are not available
through other sources (e.g.: Federal Section 8 housing certificates and vouchers
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or Emergency Shelter Allowances from local departments of social services).
b. Supportive services
These include, but are not limited to: intake and assessment, case management,
crisis intervention, mental health services, placement in permanent housing, drug
and alcohol abuse counseling, child care, nutritional services, referral to
community-based services, and assistance obtaining public benefits. Support
services will be funded only if connected to housing units and/or rental assistance
and if not duplicative of other services available in the community.
c. Short-term payments for rent/mortgage/utility costs to prevent homelessness
Such assistance may not be provided to any individual for costs accruing over a
period of more than 21 weeks in any 52-week period. (This limitation does not
apply to long-term rental assistance.) Applicants must demonstrate a plan to help
eligible individuals avoid the need for ongoing short-term assistance.
Group 2 – Lower Priority Activities
While the following activities can represent useful components of an overall housing
strategy, they are a lesser priority because they may not directly expand the number of
new housing units available to persons with HIV/AIDS or there may be other resources
available to meet these needs.
d. Technical assistance
Activities to coordinate and assist in the development of housing resources for
persons with HIV/AIDS and their families. Applicants proposing these activities must
demonstrate that, if funded, their efforts are likely to result in making additional
housing available to people with HIV/AIDS.
e. Operating costs for housing
This includes costs for maintenance, security, insurance, utilities, furnishings,
equipment, staff and other operating costs for community residences and SRO’s.
Applicants requesting funds for operating costs must have housing units in operation
whose operating costs cannot be covered by other funding sources.
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f. Housing information and referral services to help individuals obtain housing
Services to help individuals with HIV/AIDS locate, acquire, finance and maintain
housing. Such services may include counseling, information, and referral as well as
fair housing counseling to address housing discrimination. Applicants proposing this
activity must demonstrate that the proposed services will have a significant impact on
the persons served (i.e., leading to placement in permanent housing) and are
services that are not available from existing providers.
g. Lease or repair of facilities to provide housing and services
Very limited funds may be available for the lease or repair of facilities that house
persons with HIV/AIDS. However, compelling need must be demonstrated.
Applicants must show that they have been unable to access other sources of capital
financing for these purposes.
Please note: Certain categories of activities eligible for funding under HOPWA require an
extensive environmental review. HUD has determined that the following categories of activity
are not subject to the HUD environmental review process:
Tenant-based rental assistance
Supportive services
Short-term payments for rent/mortgage/utility costs
Technical assistance
Operating costs
Information services
Resource identification and planning activities
Administrative expenses
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IV. ELIGIBLE APPLICANTS
Charitable corporations, not-for-profit organizations, and public housing agencies may submit
applications under this RFP. Applications may be made by one organization or by two or more
organizations acting together. In the latter instance, a lead agency must be clearly identified.
While the Federal funds made available directly to New York State for distribution statewide are
quite limited (approximately $1.8 million annually), the Federal Fiscal Year 2008 HOPWA
funding formula has resulted in direct allocations to the following localities within New York
State:
$56,811,177 to the City of New York to be shared with Westchester and
Rockland Counties and the City of New Rochelle;
$1,675,000 to the City of Islip to be shared with Nassau and Suffolk Counties;
$640,000 to the City of Rochester to be shared with Monroe, Genesee,
Livingston, Orleans, and Ontario Counties;
$507,000 to the City of Buffalo to be shared with Erie and Niagara Counties;
$462,000 to the City of Albany to be shared with Albany, Rensselaer,
Schenectady, Montgomery, Schoharie and Saratoga Counties; and
$947,000 to the City of Poughkeepsie to be shared with Dutchess and Orange
Counties.
Potential applicants intending to serve clients who reside in the above-listed
municipalities and/or counties are not eligible to apply for funding under this RFP, unless
a conflict of interest exists prohibiting an applicant from applying for funds through one
of the above-listed municipalities. In addition, applicants whose headquarters are
located in the above-listed municipalities and/or counties but are intending to serve
clients who reside outside those areas are eligible to apply. Organizations wishing to
serve persons residing in the above-listed areas are urged to contact the appropriate
local agencies regarding the availability of funding.
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V. ELIGIBLE SERVICES AND COSTS
In the case of applications proposing to provide housing information and referral services, all
individuals with HIV/AIDS are eligible for services, regardless of income. Eligibility for
individuals with AIDS/HIV receiving rental assistance must meet the guidelines in 24 CFR 574
found in Attachment A. Please see Section III, Program Description/Eligible Activities for other
eligible services.
Eligible costs for HOPWA shall be directly related to eligible activities (see Section III) and shall
include:
personnel costs incurred in the provision of eligible assistance and/or support services,
maintenance and operation, or administrative activities;
other than personal services costs directly associated with the eligible HOPWA activities,
including subsidies for long-term and short-term rent assistance (see Non-Personal Services
Budget Categories - Section I of the Application - for a detailed explanation);
VI. INELIGIBLE SERVICES AND COSTS
Equipment costing over $5,000 and having a useful life greater than one year should be leased
rather than purchased. If a lease option is not possible, you are required to obtain three price
quotes and must receive prior approval for the purchase from New York State OTDA.
Mortgage payments cannot be reimbursed under long-term rental assistance. In an emergency
situation, mortgage payments may be reimbursed under short-term assistance for a term not to
exceed twenty-one weeks to eligible recipients who are the owners of the mortgaged property.
VII. ELIGIBLE POPULATION
Persons eligible to receive services or assistance under HOPWA are low-income individuals
with documented HIV infection, HIV-related illness, or AIDS (hereinafter “HIV/AIDS”) and their
families. In the case of applications proposing to provide housing information and referral
services, all individuals with HIV/AIDS are eligible for services, regardless of income. For the
purposes of this RFP, the definition of AIDS is that found in 24 CFR 574.3. NYS OTDA will use
the HUD definition of a “low income” person or family defined in 42 USC 12902, as one whose
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income does not exceed 80% of the median income for the area, as determined by the
Secretary of HUD. HUD may establish other income ceilings due to varying local factors.
VIII. LOCAL APPROVAL
The HOPWA regulations require the approval of local government before the State enters into a
contract with a not-for-profit organization to conduct HOPWA-related activities.
A Certification of Local Approval form is included in the Application (Section K). Depending on
the nature and geographic scope of the project, this form could be signed by the County
Planning Office, the County Executive, the Mayor of the locality, or whatever entity is
responsible for certifying the HUD Consolidated Plan in the locality. (The Consolidated Plan is a
Federal mandate to coordinate planned housing activity at every level of government.)
While the completed form is required from the local government before a contract can be
signed, we recognize that in rare instances it may not be available at the time of application. In
such cases, the applicant must explain the circumstances in the application and describe efforts
to obtain local approval. This approval must be obtained prior to execution of any
contract.
IX. MAINTENANCE OF EFFORT
HUD regulations prohibit using funds for the replacement of other funds made available or
designated by State or local governments. Applicants must clearly demonstrate that such
supplantation of existing funds has not occurred.
X. SELECTION PROCESS
Awards will be based on a demonstrated need and best value. Weight will be given to the cost
effectiveness of each proposal. OTDA staff will review all proposals, assisted by such other
State personnel as it deems appropriate. In addition to a staff review, OTDA reserves the right
to conduct site visits and solicit the opinion of other sources of funding agents prior to making a
funding decision.
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Proposals will be rated based on the following criteria:
Completeness of the application.
Responsiveness of the application to the RFP.
Clarity of the expected results of the program and the potential for their
achievement.
Applicant’s contractual performance history with OTDA.
Evidence that the applicant understands the support services needs of the
individuals and/or families to be served, understands the services needed to help
individuals and/or families obtain their maximum degree of independence, and
evidence that the applicant has the ability to provide such services successfully.
Demonstrated fiscal viability of the proposal and fiscal responsibility of the
applicant.
Programmatic feasibility of the proposed program within the time outlined.
Willingness of the applicant to adhere to all HUD guidelines and regulations
regarding HOPWA.
Competitive scoring breakout: Applicant Documentation 5%
Documentation of Need 20%
Program Plan 30%
Agency Information 15%
Budget 30%
Regardless of score, OTDA reserves the right to fund or not fund an application based on
other relevant information, such as an agency’s financial position, vendor responsibility
determination, and/or the status of the NYS Office of the Attorney General Charities
registration filing.
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Awards will be made in order of the highest scoring proposals until all available funds are
exhausted, with the following exceptions:
1. If there are other viable proposals, no one applicant will be awarded more than 20% of
the total available funds.
2. The lowest scored awarded proposal may not receive the entire requested amount if
there are insufficient funds remaining.
3. The requested amount may be reduced by all ineligible expenses.
4. Applicants are encouraged to develop cost effective proposals. For those applicants
seeking continued funding, past spending practices and performance may be considered
when determining award amounts. In the event that OTDA has determined via
competitive score that an existing grantee with a history of unspent contract monies
should be awarded new funds, OTDA reserves the right to reduce the award based on
the contractual history and the reasonableness of the request. In such an instance the
reduced award would not exceed 125% of the grantee’s past spending practices.
Existing grantees should thoroughly justify the need for the additional funds if requesting
an amount in excess of past awards.
OTDA reserves the right not to make any award in response to this RFP. OTDA also
reserves the right to award amounts greater or less than the requested amount.
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XI. HOW TO APPLY
A completed application, as outlined below, must be submitted and received by the Bureau of
Contract Management no later than 3:00 p.m., Tuesday, July 14, 2009. Any proposal
received after the deadline will be reviewed at the discretion of OTDA. Telefaxed applications or
applications sent over the Internet will not be accepted. You may, however, request that the
excel budget workbook be e-mailed. While a hard copy of the budget must be included in the
original application you may send a copy of the excel budget workbook by e-mail to:
Linda.Camoin@otda.state.ny.us. In addition, this Request for Proposals and application will be
posted on the OTDA website (www.otda.state.ny.us).
Send the original and two (2) copies of the entire application to:
Theresa Brown
NYS Office of Temporary and Disability Assistance
Bureau of Contract Management, 13B
40 North Pearl Street
Albany, NY 12243
Attention: Housing Opportunities for Persons with AIDS Program
XII. AWARD PROCEDURES
Upon approval of funding recommendations by the OTDA, award notices and instructions about
contract development will be sent to successful applicants. OTDA reserves the right to
negotiate any aspect of a proposal in order to ensure that the final agreement meets HOPWA
program objectives. Awardees will be asked to develop a detailed implementation plan that sets
forth the program goals and provides time frames for the performance of those goals. This RFP
governs the provision of HOPWA services for a three (3) year contract cycle to be funded
annually for one (1) year periods. This contract may be renewed for two additional (12) twelve
month periods (subject to approval by the New York State Attorney General and the Office of
the State Comptroller) depending upon the availability of continued HOPWA funding, the need
for the services, satisfactory performance, and at the sole discretion of the OTDA. For those
applicants selected as a result of this Request for Proposals (RFP), subsequent years’ funding
may be at a decreased level.
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Entities not selected for funding will be notified by mail of OTDA's decision. OTDA will, upon
request, meet with unsuccessful applicants to discuss why the applicant was not selected for
funding. Such requests must be made by the applicant within 90 days of the notification of the
unsuccessful application.
XIII. REPORTS AND RECORD KEEPING
Narrative and tabular data reports will be required on at least a quarterly basis, these will
describe the progress of HOPWA activities, the numbers of individuals and families served, and
continuing needs for services. A reporting format will be distributed to funded grantees.
Contractors must ensure that books, records, documents and other evidence associated with
expenses of the grant are maintained. These records must document all costs of materials,
equipment, supplies, services, building costs and all other costs and expenses for which
reimbursement are claimed or payment is made under the grant. All expenditures shall be
reported on an accrual basis.
All records pertaining to this contract including financial audits, budget, plans/drafts, supporting
documents, statistical records, etc., must be retained for a period of at least six (6) years
following submission of the final expenditure report.
In the event that any claim, audit, litigation or State/Federal investigation is commenced before
the expiration of the aforementioned record retention period, the records must be retained by
the contractor until all claims or findings regarding the records are finally resolved.
NYS OTDA or its designees shall have access to any records relevant to the project, including
books, documents, photographs, correspondence, and records to make audit, examinations,
transcripts, and excerpts. If OTDA determines that such records possess long term or historic
value, they must, upon request of OTDA, be transferred to OTDA.
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XIV. GENERAL TERMS AND CONDITIONS
Contract Execution
The contract period for this RFP will commence on January 1, 2010 and run through December
31, 2012. It is anticipated that successful applicants will receive contracts with funding for a
three (3) year period, to be funded annually for one (1) year periods. This contract may be
renewed for two additional (12) twelve month periods (subject to approval by the New York
State Attorney General and the Office of the State Comptroller) depending upon the availability
of continued HOPWA funding, the need for the services, satisfactory performance, and at the
sole discretion of OTDA. For those applicants selected as a result of this Request for Proposals
(RFP), subsequent years’ funding may be at a decreased level.
OTDA reserves the right to consider proposals in response to this RFP, but not funded at this
time, for any additional funding that may become available in the future. Updated information
will be requested as deemed necessary by OTDA. OTDA also reserves the right to solicit and
accept new proposals, as additional funding becomes available.
Contractors will be required to provide quarterly and annual data reporting to OTDA.
Contractors shall provide OTDA or its designee access to program sites and records during the
course of the project. Failure to do so may result in immediate termination of the contract.
The terms and conditions for all funded projects are specified in a detailed contract which must
be signed by OTDA and approved by the New York State Office of the State Comptroller and
the New York State Office of the Attorney General before any work is begun or payments are
made. Successful applicants will be sent the complete standard NYS OTDA contract for
execution. Anyone not familiar with this set of conditions, or those who would like to review the
contract language before award notifications are made, can find the language on the OTDA
website at http://www.otda.state.ny.us. Applicants are encouraged to review a copy of the
contract before submitting an application. The AGREEMENT section of the application pages
provides a summary of the basic provisions of the contract.
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It is the policy of OTDA to encourage the employment of qualified applicants/recipients of public
assistance by both public organizations and private enterprises that are under contractual
agreement to OTDA for the provision of goods and services. OTDA may require the Contractor
to demonstrate how the Contractor has complied or will comply with the aforesaid policy.
Equal Employment Opportunity/Affirmative Action (EEO/AA)
The Agency is in full accord with the aims and efforts of the State of New York to promote equal
opportunity for all persons and to promote equality of economic opportunity for minority group
members and women who own business enterprises, and to ensure there are no barriers,
through active programs, that unreasonably impair access by Minority and Women-Owned
Business Enterprises (M/WBE) to State contracting opportunities.
Prospective Offerors to this RFP are subject to the provisions of Article 15-A of the Executive
Law and regulations issued thereunder.
1. Contractors and subcontractors shall undertake or continue existing programs of
affirmative action to ensure that minority group members and women are afforded
equal employment opportunities without discrimination, To the extent required by
Article 15 of the Executive Law (also known as the Human Rights Law) and all other
State and Federal statutory and constitutional non-discrimination provisions, because
of race, religion/creed, color, national origin, sex, age, disability, sexual orientation,
military status, predisposing genetic characteristics or marital status. For these
purposes, affirmative action shall apply in the areas of recruitment, employment, job
assignment, promotion, upgrading, demotion, transfer, layoff, or termination and rates
of pay or other forms of compensation. Prior to the award of a State contract, the
Contractor shall submit an Equal Employment Opportunity (EEO) Policy Statement to
the contracting agency within the time frame established by that agency.
2. The Contractor’s EEO Policy Statement shall contain, but not necessarily be limited
to, and the Contractor, as a precondition to entering into a valid and binding State
contract, shall, during the performance of the State contract, agree to the following:
(a) To the extent required by Article 15 of the Executive Law (also known as the
Human Rights Law) and all other State and Federal statutory and constitutional
non-discrimination provisions, the contractor will not discriminate against any
16
employee or applicant for employment because of race, religion/creed, color,
national origin, sex, age, disability, sexual orientation, military status,
predisposing genetic characteristics or marital status, will undertake or continue
existing programs of affirmative action to ensure that minority group members
and women are afforded equal employment opportunities without discrimination,
and shall make and document its conscientious and active efforts to employ and
utilize minority group members and women in its work force on State contracts.
(b) The Contractor shall state in all solicitations or advertisements for employees
that, in the performance of the State contract, all qualified applicants will be
afforded equal employment opportunities without discrimination because of
race, religion/creed, color, national origin, sex, age, disability, sexual orientation,
military status, predisposing genetic characteristics or marital status.
(c) At the request of the contracting agency, the Contractor shall request each
employment agency, labor union, or authorized representative of workers with
which it has a collective bargaining or other agreement or understanding, to
furnish a written statement that such employment agency, labor union, or
representative will not discriminate on the basis of race, religion/creed, color,
national origin, sex, age, disability, sexual orientation, military status,
predisposing genetic characteristics or marital status and that such union or
representative will affirmatively cooperate in the implementation of the
Contractor’s obligations herein.
3. Except for construction contracts, prior to an award of a State contract, the Contractor
shall submit to the contracting agency a staffing plan of the anticipated work force to
be utilized on the State contract. To ensure compliance with this requirement, the
contractor shall submit a staffing plan to document the composition of the proposed
workforce to be utilized in the performance of this contract broken down by the
specified categories listed, including ethnic background, gender, and Federal
occupational categories. Contractors shall complete the staffing plan form and submit
it as part of their bid or proposal or within a reasonable time thereafter, but no later
than the time of award of the contract. Once a contract has been awarded, the
Contractor is responsible to update NYS OTDA on any changes to the staffing plan
submitted.
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4. Contractors are required to submit a Subcontracting Utilization Form, if applicable,
with their bid or proposal. The Subcontracting Utilization Plan shall list NYS Certified
minority and women owned business enterprises which the Contractor intends to use
to perform the state contract and a description of the contract scope of work. The
Subcontracting Utilization Plan also shall list and the estimated or, if known, actual
dollar amounts to be paid.
5. After an award of a State contract, the Contractor shall submit to the contracting
agency a periodic report on actual work force and subcontractor utilization, as well as
purchasing of supplies. The agency will prescribe the reporting format, schedule for
report submission and specific information to be included in each report.
6. For purposes of this procurement the goals for subcontracting with Minority and
Women-Owned Business Enterprises respectively are 5% and 5.5%. The goals for
the purchase of supplies (equipment and/or commodities, etc.) from M/WBE’s
respectively are 5% and 5.5%. The Agency goal for employment of protected class
individuals is 7% to 10% of the total dollars expended from any contract for personnel
of consultants.
The definitions of Minority and Women–Owned Business Enterprises are as follows:
Minority-Owned Business Enterprise: Any business enterprise authorized to do business in this
State which is at least fifty-one percent owned by, or in the case of a publicly owned business,
at least fifty-one percent of the stock is owned by citizens or permanent resident aliens who are
Black, Hispanic, Asian and Pacific Islander, or American Indian or Alaskan Native, and such
ownership interest is real, substantial and continuing. The minority owned ownership must have
and exercise the authority to independently control and operate the day-to-day business
decisions of the entity.
Women–Owned Business Enterprise: Any business enterprise authorized to do business in this
State which is at least fifty-one percent owned by or in the case of a publicly owned business, at
least fifty-one percent of the stock of which is owned by citizens or permanent aliens who are
women, and such ownership interest is real, substantial and continuing. The women-owned
18
ownership must have and exercise the authority to independently control and operate the day-
to-day business decisions of the entity.
Protected Class: Groups of people identified by law that are specifically protected against
discrimination or harassment. Protected class encompasses minorities, women, persons with
disabilities and others by virtue of the law or court decisions interpreting the law.
Definitions of Minority group members. A United States citizen or permanent resident alien who
is and can demonstrate membership in one of the following groups:
Black: A person having origins in any of the black African racial groups.
Hispanic: A person of Mexican, Puerto Rican, Dominican, Cuban, Central or South
American descent of either Indian or Hispanic origin, regardless of race.
Asian and/or Pacific Islander: a person having origins in any of the original peoples of
the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands.
Native American or Alaskan Native: Persons having origins in any of the original peoples
of North America.
Definition of Person With a Disability pursuant to the Americans with Disabilities Act
(ADA): any person who (a) has a physical or mental impairment that substantially limits
one or more major life activities; (b) has a record of such impairments, or (c) is regarded
as having such impairment.
The directory of certified businesses, prepared by the New York State Department of Economic
Development’s Division of Minority and Women’s Business Development (DMWBD), for use by
contractors in complying with the provisions of Executive Law, Article 15-A, and the regulations
required pursuant to said Law, will be provided for inspection by the Minority and Women
Owned Business (M/WBE) Program Manager.
19
In order to assist prospective Offerors in their attempts to successfully demonstrate effective
equal opportunity/affirmative action efforts, the Agency suggests Offerors consider any or all of
the following steps while developing their responses to this RFP:
1) Provide a list of all known M/WBEs that may appropriately serve as a subcontractor(s)
or a vendor(s) under the contract.
2) Provide a “contact” list of M/WBEs contacted for this particular RFP along with the
name of your contact and the result of the contact(s).
3) Use the M/WBEs contacted as a possible resource for additional contacts.
In the event your firm did not obtain the desired results from steps 1-3 above, the Agency
suggests that prospective Offerors consider these additional steps (and keep a contact record
of the same):
4) Contact area Minority Business Associations, Contractors Associations, Purchase
Councils or Professional Organizations serving the area in which the contract will be
performed.
5) Contact the New York State Department of Economic Development at (518) 292-5100
or Web Site www.empire.state.ny.us for assistance.
6) Contact the New York State Office of Temporary and Disability Assistance Minority
and Women Owned Business Enterprise (M/WBE) Program Manager at (212) 961-
8222.
7) Contact area community-based organizations that serve the minority community and
local elected, appointed religious or other acknowledged leaders who also may serve
as resources.
The above-noted provisions are set forth to aid prospective Offerors who may require
assistance in their attempt to comply with Agency EEO/AA initiatives. However, prospective
Offerors are at liberty to propose a course of action of their own that is reasonable and
accomplishes the aim of the aforementioned provisions.
The contractor agrees to comply with all applicable federal and state nondiscrimination statutes
including:
The Civil Rights Act of 1964, as amended; Executive Order No. 11246 entitled "Equal
Employment Opportunity," as amended by Executive Order 11375, and as supplemented
20
in Department of Labor Regulation 41 CFR Part 60; Executive Law of the State of New
York, Sections 290-299 thereof, and any rules or regulations promulgated in accordance
therewith; Section 504 of the Rehabilitation Act of 1973 and the Regulations issued
pursuant thereto contained in 45 CFR Part 84 entitled "Nondiscrimination on the Basis of
Handicap in Programs and Activities Reviewing or Benefiting from Federal Financial
Assistance"; and the Americans with Disabilities Act (ADA) of 1990 (42 U.S.C. 12101 et
seq.; the ADA Amendments Act (ADAAA) of 2008 (Public Law 110-325) and associated
regulations, including, but not limited to, those located in 28 C.F.R. Part 36and regulations
by the U.S. Equal Employment Opportunity Commission which implement the employment
provisions of the ADA and the ADAAA, (29 CFR Part 1630).
In the event that the Contractor is found through an administrative or legal action, whether
brought in conjunction with this contract or any other activity engaged in by the Contractor,
to have violated any of the laws recited herein in relation to the Contractor’s duty to ensure
equal employment to protected class members, the Agency may, in its discretion,
determine that the Contractor has breached this Agreement.
The Contractor is required to demonstrate effective affirmative action efforts and EEO
efforts, and to ensure employment of protected class members. The Contractor must
possess and may upon request be required to submit to the Agency a copy of an
Affirmative Action Plan which is in full compliance with applicable requirements of Federal
and State statutes.
Additionally, the Contractor and any of its subcontractors shall be bound by the applicable
provisions of Article 15-A of the Executive Law, participation by minority group members
and women with respect to State contracts, including Section 316 thereof, and any rules or
regulations adopted pursuant thereto. The Contractor also agrees that any goal
percentages contained in this Contract are subject to the requirements of Article 15-A of
the Executive Law and regulations adopted pursuant thereto.
The Contractor shall be required to submit reports as required by the Agency concerning
the Contractor's compliance with the above provisions, relating to the procurement of
21
services, equipment and or commodities, subcontracting, staffing plans and for
achievement of employment goals. The Minority and Women Owned Business Enterprise
(M/WBE) Program Manager and the Bureau of Equal Opportunity Development (EOD)
shall determine the format of such reports of the Agency. The Contractor agrees to make
available to the M/WBE Program Manager and to EOD, upon request, the information and
data used in compiling such reports.
22
NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE
Bureau of Housing and Shelter Services
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS PROGRAM (HOPWA)
2009 APPLICATION
XV. APPLICATION GUIDELINES
Section A – APPLICANT DOCUMENTATION
Executive Proposal Summary
Provide concise summary of proposal and complete General Information.
Applicant Documentation Attachments:
Attach your agency’s most recent Audited Financial Report (should not be
older than one year from date of RFP application submission)
Attach your agency’s Board of Directors Profile
Attach your agency’s Certificate of Incorporation
Attach your agency’s Equal Employment Opportunity policy. It should
comply with the Federal Equal Opportunity Act of 1972 as amended.
Attach documentation of the annual NYS charities registration filing. It
should be within the past 12 months or provide an explanation of the delay.
Section B – DOCUMENTATION OF NEED
Community Description
Describe the community to be served.
Target Population
Describe the population to be served.
Gap Analysis
Provide documentation of the need for emergency services in the proposed
community to be served, and describe how your proposal will fill that gap.
Section C – PROGRAM PLAN
Program Description
Describe your proposed program.
Program Implementation
Describe your organization’s capacity to implement the program
Program Outcomes
Describe your proposed program outcomes in quantifiable and measurable terms.
Section D – AGENCY INFORMATION
Organization Background Information
Describe the organizational structure of your agency.
Attach Copy of: Current Organizational Chart.
Program Evaluation
To be completed by all current HOPWA contractors. If any HOPWA funds have been
received during the last three years, describe the use of such funds and the benefits
realized by the individuals receiving services. If no HOPWA funds were received
during the last three years, label the form “Not Applicable” and include it with your
application.
23
Funding Agency Contact Information Form
Complete all applicable sections, and return with the application.
Agency Agreement Form
Sign, complete, and return with the application.
Organizational Status
Completed for the applicant and any subcontractors included in the proposed
program.
Subcontracting Utilization Form
Completed by the applicant and submitted with the application form, for projects
proposing to utilize subcontractors.
Offerors Identification Form
Sign, complete, and return with the application.
Project Staffing Plan Form
Complete this form and submit it as part of the application packet.
Contractor/Subcontractor Background Questionnaire
Complete this form and submit it as part of the application packet. Any proposed
subcontractor also must complete this form if the value of the subcontract will be in
excess of $10,000.
Section E – BUDGET (Budget forms are available in excel at www.otda.state.ny.us)
Budget Instructions
All applicants should include a fully developed Budget Statement, Personal Services
Costs Budget and Non-Personal Services Budget.
Budget Summary of Proposed Eligible Activities
All category totals from individual budget pages should transfer to the Budget
Statement sheet.
Personnel Services Budget Statement
The Explanation/Justification following the Personnel Service budget should explain
the personnel and job duties for which HOPWA funds are requested.
Non-Personnel Services Budgets
If the applicant is requesting funds in support of more than one eligible activity, each
individual expense should be listed on the Non-Personnel Services Budget. The
entire amount for the categories should be reflected in the budget summary and
Statement sheets. The Explanation/Justification following each component of the
budget must explain the basis for the dollar amount. (For example: Travel Funds are
being used for staff transportation estimated at 100 miles @ $0.505 per mile.)
APPLICATION CHECK LIST
Complete check list to verify all required forms have been submitted. Packets that do
not include required forms and documents will lose points.
24
Applicants must submit an original and two (2) copies of the completed application and
all attachments to:
Theresa Brown
New York State Office of Temporary and Disability Assistance
Bureau of Contract Management
40 North Pearl Street
Albany, NY 12243
Attention: Housing Opportunities for Persons with AIDS Program
Applications must be received at the address listed above
by July 14, 2009 at 3:00 p.m.
Telefaxed applications or applications sent electronically over the Internet will NOT be
accepted.
OTDA reserves the right to accept applications received after the deadline, if
it is determined to be in the best interests of the OTDA. Please complete the
final checklist prior to submitting application.
25
A.) APPLICANT DOCUMENTATION
EXECUTIVE PROPOSAL SUMMARY
APPLICANT NAME
COUNTY
1/1/10-12/31/10 1/1/11-12/31/11 1/1/12-12/31/12
ANTICIPATED # OF
INDIVIDUALS TO BE
SERVED (ANNUAL
UNDUPLICATED
COUNT)
AMOUNT REQUESTED
$
SUPPORT SERVICES
$
SHORT-TERM RENTAL
ASSISTANCE
$
LONG TERM RENTAL
ASSISTANCE
$
FACILITY HOUSING
ASSISTANCE
$
OTHER SERVICES
$
PROGRAM TOTAL
26
EXECUTIVE PROPOSAL NARRATIVE:
Provide a one-paragraph summary of your organization’s HOPWA proposal.
(Suggested format):
Organization is requesting amount of request to serve # of individuals who are low-income
persons with AIDS or HIV-related illnesses and their families in county/city. Funds will be used
to provide/enhance which housing and related support services to this population. Funds
will pay for partial salary of what positions. Experience in providing housing and support
services to those with HIV/AIDS includes what activities for how many years.
EXAMPLE:
Agency ABC is requesting $200,000 to serve 50 individuals who are low-income persons with
AIDS or HIV-related illnesses and their families in Schenectady, Schenectady County. Funds
will be used to provide long term rental assistance and case management services to this
population. Funds will pay for partial salary of the program manager and case manager.
Experience in providing housing and support services to those with HIV/AIDS includes providing
long term and short term rental assistance for ten years.
27
NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE
Bureau of Housing and Shelter Services
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS PROGRAM (HOPWA)
2009 APPLICATION
GENERAL INFORMATION
HOPWA APPLICANT PROJECT INFORMATION
APPLICANT NAME (Entity):
______________________________________________________________
CHIEF ELECTED OFFICIAL
or EXECUTIVE DIRECTOR________________________________________
PROGRAM CONTACT____________________________________________
BUSINESS ADDRESS:
Street Address ___________________________ P.O. Box_______________
(required)
City ________________________, State ______ Zip Code_______________
COUNTY/ COUNTIES (WHERE SERVICES ARE TO BE
PROVIDED)_________________________
PROJECT ADDRESS (if other than business address):
______________________________________________________________
DAYTIME PHONE: (____)_____________
SITE PHONE NUMBER:(____)_________________
Email Address:__________________________________________________
What is your organization’s Federal Employer Identification
number?_____________________________
Applicant Fiscal Year: (Example: July 1 - June 30)?
___________________________________________
Please provide the following identifying information regarding the project:
Community District(s):___________________________________
Federal Congressional District(s):__________________________
State Assembly District(s): _______________________________
State Senate District(s):__________________________________
28
What is your organization’s six digit State Registered Charitable Organization number?
__ __ __ __ __ __
Date of last certification? ___________________
Is your organization current with the NYS Office of the Attorney General Charities registration
filing requirements? ______ YES ______ No
If not, why?
____________________________________________________________________
29
B.) DOCUMENTATION OF NEED
This portion of the application package is designed in a question and answer format. Each
response should restate the question and then provide a detailed response. Please adhere to
the format set forth in the package. Failure to address each question completely will adversely
affect the competitiveness of your proposal. All information provided should be verifiable.
Source documentation, including date, should be identified. Although source documents may
be attached to the application, only the information provided in direct response to the question
will be evaluated and scored. The applicant is required to analyze and summarize data from
supporting documents.
1.) COMMUNITY DESCRIPTION
Provide a detailed description and analysis of the community you plan to serve. Please provide
current statistical data to support your description. Applicant should describe the
county(s)/city(s) where services will be provided. Please include:
a) The geographic area(s) to be served and identify the Fair Market Rents for that area
b) What is your community’s estimated number and percentage/population of individuals
and/or families who are living with HIV/AIDS?
c) What is your community’s estimated number housing units dedicated for individuals and
families living with HIV/AIDS?
d) Describe the need in your community for housing and support services for those
individuals who are low-income and living with HIV/AIDS and their families.
e) What other community agencies provide relevant services and how do you propose to
work with them?
f) Describe how your proposal will enhance existing services.
g) Please provide your agency’s insight into the community. Sometimes statistics do not
paint the whole picture. What is your agency’s experience regarding the statistics listed
above? According to your agency’s experience, how accessible are employment
opportunities for the population you wish to serve? According to your agency’s
experience, what is the availability and quality of affordable housing for the population
you wish to serve? According to your agency’s experience, what other significant factors
exist for the population you wish to serve?
30
2.) TARGET POPULATION
Describe the population(s) to be served. Information should be based on statistical data as well
as your agency’s experience.
a) Provide the demographics and characteristics of the target population to be served.
b) Describe the typical living situation of the majority of proposed program participants
prior to being referred to your agency. Be sure to identify anticipated referral sources.
c) What are the housing and support service needs of the target population based on an
analysis of resources available within the community and target population
characteristics? Describe the special needs of each population you propose to serve.
Include how those needs impact their ability to secure and/or maintain permanent
housing and achieve self-sufficiency. Please respond to the specific needs
associated with each target population listed in question a) above.
d) Provide the estimated projected number of individuals to be served under this
proposal, by type of service to be provided, and describe and quantify the expected
outcomes.
3.) GAP ANALYSIS
Describe how your proposed project will meet an identified local need. (Please be sure to
integrate the community section, target population, and the gap analysis.)
a) Describe any critical gaps in services to those low-income individuals living with
HIV/AIDS in the area that you propose to serve as supported by the description of the
community and the proposed target population you identified in the previous section.
b) Will the services you are proposing respond to the gaps in services identified in question
a) above?
c) Discuss how duplication of effort will be avoided if you are successful in your bid for
HOPWA funds. Describe your agency’s involvement with the county’s Continuum of
Care Plan. In the context of the Plan, how does your agency avoid duplication and
identify needs within the community?
C.) PROGRAM PLAN
1.) PROGRAM DESCRIPTION
a) Describe the assistance and/or support services the proposed program expects to
provide.
b) Explain how the proposed program will meet the needs of the participants and enhance
their self-sufficiency.
c) Provide a detailed description of the day-to-day operations of the proposed program.
Describe the process for program participants from the point of referral to discharge (if
applicable).
31
d) Explain how your agency will perform outreach for the proposed program, and describe
the main source of program participant referrals. Also, describe your agency’s system of
communication with those referral sources.
e) Provide evidence as to how outreach efforts will be non-discriminative in nature.
f) Describe the intake process, including eligibility for assistance.
g) Describe the program’s staffing pattern, including job descriptions and staff qualifications
and experience.
h) Detail how program staff will interact with management staff within the agency.
1a.) Describe the physical site
(This section applies only to applications that request funding for support services and/or
operating costs connected with a particular housing facility or residence. Applications not
requesting such funds should indicate: “The proposed program is not connected to a
particular housing facility or residence.”)
1) Briefly describe the facility site(s), including location, size, type of building(s), and type of
housing (e.g. emergency, transitional, permanent, scattered site).
2) What is the total number of units and beds? What is the total number of units and beds
serving persons with HIV/AIDS?
3) Indicate the operational status of each project for which funding is sought (e.g. “in
development”, “in construction”, “operational”). If the site is not yet operational, when is it
scheduled to become operational?
2.) PROGRAM IMPLEMENTATION
a) Please provide a detailed time line that demonstrates your agency’s ability to implement
this program in a timely fashion, including your plan to fully expend all of the funds within
the three year contract term.
b) If providing rental assistance, detail the proposed mechanism for assuring compliance
with HUD’s Housing Quality Standards.
c) Describe how the funds will not supplant any existing or anticipated public or private
funding sources.
d) List the additional sources and amounts of funding anticipated to be available in support
of the proposed program.
e) Describe the plan to insure stable program participation levels. The plan should include
participant turnover procedures.
f) Describe the plan to manage and maintain connections to community-at-large.
32
3.) PROGRAM OUTCOMES
Please provide expected results, for each proposed service, in quantifiable and measurable
terms.
a) Provide number of households expected to be served for each type of assistance and/or
service provided, and describe the expected outcome.
b) Provide number of households expected to experience housing stability
c) Provide the potential for achievement of these results.
d) Describe what form of follow-up verification you will use to show the extent to which you
have achieved the anticipated results.
e) Discuss how your agency will monitor the success of program participants.
D.) AGENCY INFORMATION
1.) ORGANIZATION BACKGROUND INFORMATION
a) Briefly describe the history of your agency and provide a general description of the
agency’s structure. (Please include an organizational chart.)
b) Describe the resources and skills your organization will commit to carry out the proposed
HOPWA funded program.
c) Provide evidence that your organization has the ability to administer all financial and
programmatic aspects of this initiative.
d) Describe your agency’s experience in providing housing and/or related support service
services to this population.
ATTACH COPY OF: YOUR AGENCY’S ORGANIZATION CHART
33
2.) Program Evaluation
To be completed by those applicants in receipt of HOPWA funds. If any HOPWA funds
have been received during the last three years, describe the use of such funds and the
benefits realized by the individuals served by the funded projects.
If no HOPWA funds were received during the last three years, label the forms “Not
Applicable” and include it with your application.
1. Provide a listing of HOPWA funds received from NYS OTDA during the past three years.
Year/ Assistance/Service Use of Funds
Award Amount Provided
Example: Long-term rental assistance; 2 Part-time staff;
06-07 / $100,000 short-term rental assistance Case manager; rental payment
06-07
07-08
08-09
34
2. Provide the number of households served by HOPWA funds during the past three years.
Year Assistance/ Projected Actual Number of Comment
Service Provided Number of Individuals
Individuals to be Served
Served
06-
07
07-
08
08-
09
3. Provide justification for the continued need for HOPWA funds (please elaborate with specific
success or problems).
35
NEW YORK STATE OFFICE of TEMPORARY AND DISABILITY ASSISTANCE
Bureau of Housing and Shelter Services
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS PROGRAM (HOPWA)
2009 APPLICATION
3) FUNDING AGENCY CONTACT INFORMATION FORM
Lists all sources of agency funding received during the last three-year period from Federal,
State, county or other local government. Please include the applicable contract manager(s) as
a reference(s).
Name of Funding Source Purpose of Time Period of Funding
Funding Source Representative Funding Funding Amount
(Individual
Name and
Phone Number)
36
NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE
Bureau of Housing and Shelter Services
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS PROGRAM (HOPWA)
2009 APPLICATION
4.) AGENCY AGREEMENT
It is understood and agreed to by the applicant that (1) This RFP does not commit the New York
State Office of Temporary and Disability Assistance (OTDA) to award any contracts, pay the
costs incurred in the preparation of response to this RFP, or to procure or contract services. (2)
OTDA reserves the right to amend, modify or withdraw this RFP and to reject any proposals
submitted, and may exercise such right at any time and without notice and without liability to any
offer or other parties for their expenses incurred in the preparation of a proposal or otherwise.
Proposals will be prepared at the sole cost and expense of the agency. (3) OTDA reserves the
right to accept or reject any or all proposals that do not completely conform to the instructions
given in the RFP, including time frames for submission thereof. (4) Submission of a proposal
will be deemed to be the consent of the applicant to any inquiry made by OTDA of third parties
with regard to the applicant's experience or other matters deemed by OTDA relevant to the
proposal. (5) Funds granted for this project will be used only for the conduct of the project as
approved. (6) The contract may be terminated in whole, or in part, by OTDA. Such termination
shall not affect obligations incurred under the contract prior to the effective date of such
termination. (7) When funds are advanced any unexpended balance or funds unaccounted for
at the end of the approved period must be returned. (8) Any significant revision of the approved
project proposal must be in writing by the contractor prior to enactment of the change. (9)
Progress reports must be submitted quarterly and annually. The final program and financial
reports must be submitted within 30 days after the project terminates. Necessary records and
accounts including financial and property controls will be maintained and made available to
OTDA for audit purposes. (10) All reports of investigations, studies, and publications made as a
result of this proposal must acknowledge the support provided by OTDA. (11) All personal
information concerning individuals served or studies conducted under the project are
confidential and such information may not be disclosed to unauthorized persons, corporations,
or agencies. (12) OTDA reserves a royalty free non-exclusive license to use and to authorize
others to use all copyrighted material resulting from this project. (13) Successful applicants will
be subject to the State's prompt contracting law. (14) Selected contractors agree to be bound
by the Affirmative Action/Equal Opportunities anti-discrimination provisions as more fully set
forth in Section XIV, General Terms and Conditions of this RFP.
OTDA reserves the right, if funds become available, to make additional awards based on the
remaining proposals submitted to this RFP, in lieu of releasing a new RFP, if deemed to be in
the best interest of the State. In the event funds become available, projects would be awarded
funding in a manner consistent with the award methodology set forth in this Request for
Proposals.
This RFP governs the provision of HOPWA services for a three (3) year contract cycle to be
funded annually for one (1) year periods depending upon the availability of continued HOPWA
funding, satisfactory performance, and the discretion of the OTDA. For those applicants
selected as a result of this Request for Proposals (RFP), subsequent year's funding may be at a
decreased or increased level.
37
Contract may be renewed for two additional (12) twelve month periods (subject to approval by
the New York State Attorney General and the Office of the State Comptroller) depending upon
the availability of continued HOPWA funding, the need for the services, satisfactory
performance, and at the sole discretion of the OTDA. Should the contract amount be increased
within the three year contract cycle, the agreement must be formally modified and approved by
the New York State Office of State Comptroller.
The applicant certifies that to the best of his/her knowledge and belief the information in
this application is true and correct, and that he/she will comply with the above agreement
if the grant is received.
(Signature of official authorized to sign for applicant) (Date)
(Typed name and title)
38
D.) AGENCY INFORMATION CONT.
5.) ORGANIZATIONAL STATUS (For Reporting Purposes)
Please identify all of the items below that apply to your organization. Definitions are as
follows:
YES NO NOT-FOR-PROFIT ORGANIZATION
To meet the definition of a Not-for-Profit Organization, an
organization must be incorporated as a not-for-profit
corporation or religious corporation or public agency under the
laws of this state or provide care and services in this state and
have been granted federal tax exempt status.
YES NO MINORITY ORGANIZATION
A Minority Organization is characterized by majority
representation of American Indians, Asian Americans, Blacks
and/or Hispanics in both policy formulation and decision-
making regarding management, service delivery and staffing
reflective of the catchment area it serves. Identify type as
appropriate:
YES NO WOMAN-OWNED ORGANIZATION
If Minority Organization, please check one of the following:
Hispanic persons of Mexican, Puerto Rican, Dominican, Cuban, Central or
South American of either Indian or Hispanic origin, regardless of race;
Black persons having origins in any of the black African racial groups not of
Hispanic origin;
Asian and Pacific islander persons having origins in any of the Far East,
southeast Asia, the Indian subcontinent or the Pacific Islands; and
American Indian or Alaskan Native persons having origins in any of the
original peoples of North America and maintaining identifiable tribal
affiliations through membership and participation of community
identification.
39
Contractor/Subcontractor Background Questionnaire
Name of Agency: _______________________ Federal Identification #_________________________
Mailing
Address:________________________________________________________________
Actual
Location:__________________________________________________________________
City: _____________________________ State: _____________________ Zip code:
____________________________
Telephone Number: ( ) ________________ Fax Number: ( )___________________
Background Questionnaire
The following section must be fully completed by the Bidder or bid will be deemed non-responsive. Where appropriate, provide
additional details using space provided or by inserting additional sheets following this part. Any proposed subcontractor must also
complete this form if the value of that subcontract will be in excess of $10,000.
1a. If you, the bidder, are a natural person, are you a New York State resident? ______ NO _____ YES
1b. If you are a corporation, are you a New York State corporation? ______ NO _____ YES
1c. Are you registered with the New York State Department of State (DOS) to do business in New York
State? ______ NO ______ YES
If no, you will be required to comply with the New York State Department of State guidelines for doing
business in New York State before you will be eligible for a Contract award. Do you agree to these ______NO ______ YES
conditions?
2. How many years has the bidder been in business? ________ # of Years
3a. Are you a certified minority owned business enterprise, certified by the NYS Department of Economic
Development? (Your company is eligible to be certified if it is at least 51% owned and controlled by minority
______NO _____ YES
group members (i.e. Black, Hispanic, Asian, Pacific Islander, American Indian or Alaskan Native)?
3b. Are you a woman owned business enterprise, certified by the NYS Department of Economic
Development? (Your company is eligible to be certified if it is at least 51% owned and controlled by women)
_____NO _____ YES
4. How many people are employed by the bidder? ________ Employees
5. Total number of people employed by the bidder:
Within New York State? ___________
Outside of New York State? ___________
Outside of United States? ___________
6. Is the bidder independently owned and operated? ______ NO ______ YES
(If no, provide details)
7. List and describe any liquidated damages assessed, and/or liens or claims over $25,000 filed against
the bidder and remaining undischarged or unsatisfied for more than 90 days, on any contracts within the
past five years. ______NO _______YES
______ N/A
40
8. Within the past five years has the bidder, any affiliate, any predecessor company or entity, any owner Check any that apply. If
of 5.0% or more of the bidder’s equity, or any director, officer, partner, or employee, or other agent of the “yes”, describe using
bidder who either routinely or frequently acts for the bidder, or has acted for the bidder at any time in additional pages if
conjunction with the pending contract, or any similar contract with New York State, been the subject of: necessary)
a) A judgment of conviction for any business-related conducts constituting a crime under state or ______ NO ______ YES
federal law?
b) A currently pending indictment for any business-related conducts constituting a crime under state ______ NO ______ YES
or federal law?
______ NO ______ YES
c) A grant of immunity for any business-related conducts constituting a crime under a state or federal
law?
______ NO ______ YES
d) A federal suspension or debarment, New York rejection of any bid or disapproval of any proposed
subcontract for lack of responsibility, denial or revocation of pre-qualification in any state, or a
voluntary exclusion agreement? ______ NO ______ YES
e) A civil or criminal investigation of the New York State Ethics Commission involving a violation(s) of Section
73 and/or Section 74 of the Public Officer’s Law?
_______ NO ______ YES
f) Any bankruptcy proceeding?
g) Any suspension or revocation of any business or professional license? _______ NO _______ YES
h) Anyone whose license to provide health care services under investigation, citation, suspension (including
suspension stayed on compliance with compulsory terms) and/or conviction by any State licensing authority
for reasons bearing on professional competence, professional conduct, or financial integrity?
_______NO ______YES
i) Any failure to notify the OTDA of any investigation, citation, suspension (including suspension stayed on
compliance with compulsory terms) and/or conviction by a State agency of a matter within its jurisdiction?
j) Any citations, Notices, violation orders, pending administrative hearings or proceedings or determinations
_______NO _______YES
for violations of:
federal, state or local health laws, rules or regulations;
unemployment insurance or workers compensation coverage or claim requirements;
ERISA (Employee Retirement Income Security ACT);
federal, state or local human rights laws; or,
federal, state security laws?
k) A grant of immunity for any business-related conducts constituting a crime under a state or federal ______ NO _______ YES
law?
l) Any federal determination of a violation of any labor law or regulation, or any OSHA serious
violation?
Was violation willful? ______ NO _______ YES
m) Any state determination of a violation of any labor law or regulation? ______ NO _______ YES
______ NO _______ YES
n) Any state determination of a Public work violation?
______ NO _______ YES
Was violation deemed willful?
______ NO _______ YES
o) A revocation of MBE or WBE certification? ______ NO _______ YES
p) A rejection of a low bid on a state contract for failure to meet statutory affirmative action or MWBE
requirements? ______ NO _______ YES
q) A consent order with the NYS Department of Environmental Conservation, or a federal or state
enforcement determination involving a construction-related violation of federal or state ______ NO _______ YES
environmental laws?
______NO _______YES
9. Does your company retain partnership or reciprocal agreements with hardware and/or software ______ NO _____ YES
companies, or with associated manufacturers in this industry?
41
10. Does the bidder hold any current contracts with the State of New York, its departments or political ______ NO ______ YES
subdivisions, valued in excess of $100,000? (If yes, provide details)
11. Does the bidder hold any current contracts with governmental entities outside of New York State, ______ NO ______ YES
valued in excess of $100,000: (If yes, provide details)
12. Your firm is responsible for providing worker’s compensation insurance pursuant to state law. The
State has the option to require proof of current worker’s compensation insurance or proof of exemption ______ NO _____ YES
if applicable. Do you comply with this requirement?
13. Your firm is responsible for providing disability insurance pursuant to state law. The State has the
option to require proof of current worker’s compensation insurance or proof of exemption if applicable.
Do you comply with this requirement? ______ NO ______ YES
14. Does your firm employ any non-U.S. citizens or resident legal aliens? _______ NO _____ YES
CERTIFICATION
The undersigned: 1) recognizes that this questionnaire is submitted for the express
purpose of inducing the New York State Office of Temporary of Disability
Assistance to award a contract or approve a subcontract; 2) acknowledges that the
Office may in its discretion, by means which it may choose, determine the truth
and accuracy of all statements made herein; 3) acknowledges that intentional
submission of false or misleading information may constitute a felony under Penal
Law 210.40 or a misdemeanor under Penal Law 210.35 or 210.45, and may also be
punishable by a fine of up to $10,000 or imprisonment of up to five years under 18
U.S.C. 1001; 4) states that the information submitted in this questionnaire and any
attached pages is true, accurate and complete; and, 5) acknowledges that
submission of false or misleading information will constitute grounds for the
Office to terminate its contract (or revoke its approval of a subcontract) with the
undersigned or the organization of which s/he is an officer.
Authorized Signature:
Name:______________________________________________________________________
Title Date
42
7.) OFFEROR’S IDENTIFICATION FORM
Name:
___________________________________________________________________________
Address:
___________________________________________________________________________
Employer Identification Number:
________________________________________________________
Company Representative
(Name/Title)
__________________________________________________________________________
Signature:
____________________________________________________________________
Telephone: __________________________________________________________
Services Provided:
_____________________________________________________________________
Please identify all of the terms below which apply to your organization.
(Definitions may be found on page 30).
Yes No
Nonprofit Organization _______ ______
Small Business _______ ______
Minority Business * _______ ______
Women-Owned Business * _______ ______
* If response is yes, and if New York State certified, please attach certification statement from
an authorizing New York State agency.
43
OTDA – 4934 .1 (Rev. 04/09) NYSOTDA
Minority And Women Owned Business Enterprise
(M/WBE) PROJECT STAFFING PLAN
FORM
Company / Grantee Information
Is Agency Not-for-Profit?
Company/Agency Contact Person:
Yes
No
Name: Address: Phone Number:
Federal ID / NYS Payee ID:
Email Address:
Phone Number:
Reporting Period: To
Staffing Plan Information
Only Includes Staff on the Project as the Date Report Completed. Determination of Ethnicity can be made by the Observation.
White
Position Title / Total Asian/Pacific Native (Not of Vietnam Era
By Gender Black Hispanic Disabled
Category Workforce Islander American Hispanic Veteran
Origin)
M F M F M F M F M F M F M F M F
Officials / Admins.
Professionals
Trainers
Technicians
Admin. Support
(Clericals)
Service /
Maintenance
Temporary
Assistance
Recipients
TOTAL
Total by % N/A
44
INSTRUCTIONS FOR COMPLETION OF
THE BUDGET SECTION
You must explain or justify all costs associated with each budget line in the
Justification/Explanation section of the budget worksheet associated with each budget
expense.
Personnel Service Expense Detail - Employees who should be included on this form are
those who will be paid in full or in part from grant funds. Any key personnel listed in narrative
must be included here. To complete this section list the titles and names of the appropriate
personnel. Next determine and enter the “Percentage of Time” this individual will spend on the
project. Accurately reflect the salaries for each category. These amounts should carry to the
“Budget Statement” under Personnel (B-1).
Fringe Benefit Detail - For all employees listed in the Personnel Service Expense Detail, you
are required to pay mandatory employer payroll taxes: Social Security (FICA), NYS
Unemployment Insurance , NYS Disability Insurance and Workers’ Compensation. You may
also provide additional fringe benefits such as pension, health, life and/or dental insurance. If
HOPWA funds are being requested to cover these expenses, the total fringe benefit and
payroll taxes chargeable to this program cannot exceed the Office of the State Comptroller’s
rate, currently the rate is up to 41.49%. You are encouraged allocate a lower percentage.
These amounts should carry to the “Budget Statement” under Fringe Benefits (B-1).
Contractual/Consultant Services - List costs for services rendered to the program under a
formal or informal contract. This category includes rental and leasing of equipment and real
estate rental. This category also includes institutions, individuals or organizations external to
the contractor which have entered into an agreement with the contractor to provide any
services outlined in or associated with the contract and whose services are to be funded under
the contract budget. ALL SUCH AGREEMENTS ARE TO BE A BONA FIDE WRITTEN
CONTRACT. If your application is funded, a copy of the consultant contract must be submitted
for approval prior to reimbursement. NYS OTDA also reserves the right to request these
documents at any time in the future. Only the pro-rated portion of the entire expenditure that is
related to the HOPWA program is allowed. SHOW JUSTIFICATION IN EXPLANATION BOX
(e.g. the full cost of rent ($1,000) x the % of space related to the program (25%) x number of
months (12) = $3,000).
Travel Costs - These costs may be reimbursed up to the NY State rate (currently the
maximum rate is $.50 ½ per mile). Only travel costs for personnel listed under Personnel
Services Costs and client travel costs are acceptable. Explain which staff will be traveling in
relation to the project, the destination, purpose and frequency of the travel. Consultant travel
expenses should be included under contractual/consultant costs.
Equipment/Supplies - Equipment is any non-consumable, tangible property having a useful
life of more than one year. Substantial equipment purchases (costing more than $5,000)
should be avoided. If contract funds are used to purchase equipment/supplies, a contractor is
required to obtain and submit 3 competitive bids and must receive OTDA prior approval. All
things being equal, contractor must purchase equipment from the lowest bidder. Equipment
rental should be listed in contractual services. The acquisition costs of “general purpose”
45
equipment and “special equipment” are defined in Office of Management and Budget Circular
A-122, “Cost Principles for Non-Profit Organizations”. Acquisition costs must be in accordance
with NYS requirements and may be evaluated to determine if leasing is a practical and cost
effective alternative.
Supplies are major supply items (e.g.: office supplies, program supplies, janitorial, etc.).
Provide an explanation of what items will be included. Justify these costs in relation to number
of staff and their programmatic functions.
Rental Assistance – Long-term rental assistance funds are available to pay on-going rental
assistance subsidies for eligible recipients. Please estimate the number and type of units (e.g.
one-bedroom, two bed-room) to be provided, the counties in which the units will be provided,
and the size of the subsidy to be provided. Rents must adhere to the fair market rents
applicable to the area in which they will be provided.
Short-term rental assistance funds are available to pay short-term rental assistance subsidies
for eligible recipients. Please estimate the number and type of payments to be made (e.g.
rent, utilities, mortgage) to be provided, and the size of the subsidy to be provided. Limitations
on the duration of subsidies are listed in the HOPWA regulations.
Other Expenses - List items not applicable under any other category. Only the pro-rated
portion of the entire expenditure that is specifically related to HOPWA is allowed.
Administrative Expenses – List costs for the administration of the program. Any cost, which
is budgeted completely or partially in an itemized direct cost category, may not be part of the
budgeted administrative costs. For example, a portion of the Bookkeeper, Executive Director,
and Program Director’s salary may be considered administrative charges, however, those
associated salaries cannot then be charged in the personal services budget. For this RFP, an
administrative rate of up to 7% may be charged with an itemized listing of costs. The
administrative cost may not include any portion of costs that are assignable to other federal,
state or funding agencies.
46
E. HOPWA BUDGET STATEMENT
On the budget form below, indicate the amount of funds being requested to support the proposed
project annually for both Personnel Services and Non-Personnel Services.
PERSONNEL COSTS
Item
1st Year Request 2nd Year Request 3rd Year Request
(as contained in the contract)
B-1. Personnel and Fringe
Personnel Services Total
NON-PERSONNEL SERVICES
Item
1st Year Request 2nd Year Request 3rd Year Request
(as contained in the contract)
B-2. Contractual/Consultants
B-3. Travel
B-4. Equipment/Supplies
B-5. Rental Assistance
B-6. Other Expenses
B-7. Administrative Expenses
Non-Personnel Services
Total
47
F. Budget Expense Details
B-1. PERSONNEL SERVICE EXPENSE DETAIL – YEAR 1
Amount
Position Title % Time on Total Annual Salary Charged to
Project (12 months) this Grant
Personnel Total – Year 1
Fringe Benefits Total Rate_____%:
Total Personnel Services Cost – Year 1
Explanation/Justification:
48
B-1. PERSONNEL SERVICE EXPENSE DETAIL – YEAR 2
Amount
Position Title % Time on Total Annual Salary Charged to
Project (12 months) this Grant
Personnel Total – Year 2
Fringe Benefits Total Rate_____%:
Total Personnel Services Cost – Year 2
Explanation/Justification:
49
B-1. PERSONNEL SERVICE EXPENSE DETAIL - YEAR 3
Amount
Position Title % Time on Total Annual Salary Charged to
Project (12 months) this Grant
Personnel Total – Year 3
Fringe Benefits Total Rate_____%:
Total Personnel Services Cost – Year 3
Explanation/Justification:
50
Non-Personnel Services Expense Details
B-2. ANNUAL CONTRACTUAL/CONSULTANT COSTS
1st Year 2nd Year 3rd Year
Item HOPWA Funds HOPWA Funds HOPWA Funds
Total
Contractual/Consultant
Costs
Explanation/ Justification:
B-3. ANNUAL TRAVEL COSTS
1st Year 2nd Year 3rd Year
Item HOPWA Funds HOPWA Funds HOPWA Funds
Total Travel Costs
Explanation/ Justification:
51
B-4. ANNUAL EQUIPMENT/SUPPLY COSTS
1st Year 2nd Year 3rd Year
Item HOPWA Funds HOPWA Funds HOPWA Funds
Equipment:
Supplies:
Total
Equipment/Supply
Costs
Explanation/ Justification:
52
B-5. ANNUAL RENTAL ASSISTANCE COSTS
1st Year 2nd Year 3rd Year
Number of HOPWA HOPWA Funds HOPWA
Item Units Funds Funds
Long-term
Rental
Assistance:
Short-term
Rental
Assistance:
Total Units
Total Rental Assistance
Costs
Explanation/ Justification:
53
B-6. ANNUAL OTHER EXPENSES
1st Year 2nd Year 3rd Year
HOPWA Funds HOPWA Funds HOPWA Funds
Item
Total Other Costs
Explanation/ Justification:
B-7. ANNUAL ADMINISTRATIVE EXPENSES
1st Year 2nd Year 3rd Year
HOPWA HOPWA HOPWA
Item Funds Funds Funds
Total
Administrative
Expenses
Explanation/Justification
54
Applicant:
____________________________________________________
G. APPLICATION CHECK LIST of Included Not Included
(Explain)
Required Forms Missing documents may
adversely affect the
overall competitive score
of your proposal.
A – APPLICANT DOCUMENTATION
Executive Proposal Summary
(Provide concise summary of proposal)
Attach Copy of: Audited Financial Report. It
should be within the last 12 months, if not
attach letter explaining why.
Attach Copy of: Board of Director’s Profile
Attach Copy of: Certificate of Incorporation
Attach Copy of: Agency’s Equal
Employment Opportunity policy. It should
comply with the Federal Equal Opportunity Act
of 1972 as amended.
Attach Documentation of NYS Charities
Filing. It should be within the last 12 months, if
not provide letter explaining why?
Attach Copy of: Worker’s Compensation
documentation
B – DOCUMENTATION OF NEED
Community Description
Describe the Community to be served
Target Population
Describe the population to be served
Gap Analysis
Describe how your proposal will fill a gap
C – PROGRAM PLAN
Program Description
Program Implementation
Program Outcomes
D – AGENCY INFORMATION
Organization Background Information
Attach copy of: Organization Chart
Program Evaluation
Funding Agency Contact Information Form
Agency Agreement Form
Organizational Status Form
55
Subcontracting Utilization Form
Contractor/ Subcontractor Background
Questionnaire
Offerors Identification Form
Project Staffing Plan Form
E – BUDGET
Budget Summary
Personnel/Non Personnel Services Budget
Statement
Non-Personnel Services Budgets
END OF APPLICATION
56
NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE
Bureau of Housing and Shelter Services
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS PROGRAM (HOPWA)
2009 APPLICATION
H. DOCUMENTATION OF CONTINUING FINANCIAL SUPPORT
NOTE: HOPWA funds cannot be used to supplant or replace local funding. This is an
example of the format that should be followed regarding certification of continuing
financial support.
AGENCY LETTERHEAD
Date
New York State Office of Temporary and Disability Assistance
Bureau of Housing Services
40 North Pearl Street, 10-B
Albany, NY 12243
Attention: Ms. Linda Camoin
To Whom It May Concern:
This is to certify that, to the best of my knowledge, the funds requested in my agency’s 2009
HOPWA application will not be used to supplant or replace local financial participation in the
proposed HOPWA program.
Sincerely,
Signature of Authorized Agency Representative
57
NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE
Bureau of Housing and Shelter Services
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA) PROGRAM
2009 APPLICATION
I. FEDERAL CERTIFICATIONS (Page 1 of 2)
I, ,
(Official authorized to sign for applicant agency) (Title)
of , hereby assure and certify
(Name of applicant agency, hereinafter referred to as " the Applicant")
that the Applicant will comply with the following items under the Housing Opportunities for
Persons with AIDS Program:
1. All requirements of 24 Code of Federal Regulations (CFR) Part 574, entitled Housing
Opportunities for Persons with AIDS (Attachment A).
2. The Applicant will comply with the environmental laws and authorities at 24 CFR Part 50,
which implements the National Environmental Policy Act and related acts. The Applicant
agrees to supply HUD with information necessary for it to perform any necessary
environmental review of each property. The Applicant will carry out mitigating measures
required by HUD or select alternate eligible property. The Applicant will not acquire,
rehabilitate, convert, lease, repair or construct property to provide housing or commit
HUD or local funds to such program activities with respect to any eligible property until
HUD approval is received. See Section 574.510 for the environmental procedures and
standards for applicants for assistance and such other information or certifications as
HUD determines to be necessary.
3. Within the designated population:
(a) The Applicant will adhere to the requirements of the Fair Housing Act (42 U.S.C.
3601-20) and implementing regulation at 24 CFR Part 100; Executive Order 11063
and implementing regulations at 24 CFR Part 107; and Title VI of the Civil Rights Act
of 1964 [42 U.S.C. 2000d] and implementing regulations issued at 24 CFR Part 1;
(b) The Applicant will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-
07) and implementing regulations at (24 CFR Part 146), prohibiting discrimination on
the basis of age; Section 504 of the Rehabilitation Act of 1973 (29 U.S.C., 794) and
implementing regulations at 45 CFR Part 84 prohibiting discrimination against
handicapped individuals; Americans with Disabilities Act (ADA) of 1990 and
regulations which implement the ADA, set forth at 42 CFR Section 12101 et seq. and
executive order 11063 and regulations under 24 CFR Part 107 prohibiting
discrimination on the basis of race, color, creed, sex or national origin;
(c) The Applicant will adhere to the requirements of Section 3 of the Housing and Urban
Development Act of 1968, (12 U.S.C. 1701a) regarding employment opportunities
for lower-income residents of the project;
(d) The Applicant will adhere to the requirements of Executive Orders 11625, 12432, and
12138, that grantee or project sponsor must make efforts to encourage the use of
minority and women’s business enterprises in connection with funded activities;
58
(e) The Applicant will establish additional procedures to ensure that interested persons
can obtain information concerning assistance under this program in cases where
established procedures are unlikely to reach persons of any particular race, color,
religion, sex, age, national origin, familial status, or handicap, who may qualify for
assistance; and
(f) The Applicant will comply with reasonable modification and accommodation
requirements of the Fair Housing Act and, as appropriate, the accessibility
requirements of the Fair Housing Act and Section 504 of the Rehabilitation Act of
1973, as amended.
4. The Applicant will certify (i.e., provide assurance of compliance as required by 49 CFR
Part 24) that it will comply with the URA, the regulations at 49 CFR Part 24, and the
requirements of Section 574.630, and shall ensure such compliance notwithstanding any
third party’s contractual obligation to the grantee to comply with these provisions.
5. The Applicant will provide that any building or structure assisted with amounts under this
part must be maintained as a facility to provide housing or assistance for eligible
beneficiaries; (i) for not less than 10 years in the case of assistance involving new
construction, substantial rehabilitation or acquisition of a building or structure; and (ii) for
not less than 3 years in cases involving non-substantial rehabilitation or repair of a
building or structure.
6. The Applicant will adhere to the policies, guidelines, and requirements of 24 CFR Part 85
(codified pursuant to OMB Circular No. A-102 and OMB Circular No. A-87) which apply to
the acceptance and use of funds under the program by grantees and Nos. A-110 and A-
122 apply as they relate to the acceptance and use of funds under this program by
project sponsors.
7. The Applicant will provide drug-free workplace in accordance with the Drug-Free
Workplace Act of 1988 (41 U.S.C. 701).
8. No Federally appropriated funds have been or will be used for lobbying the Executive or
Legislative Branches of the Federal Government as required by Section 319 of the
Department of Interior Appropriations Act (Pub. L. 101-121), as approved October 23,
1989).
9. The Applicant will implement the provisions of 24 CFR Part 24 relating to the
employment, engagement of services, awarding of contracts, or funding of any
contractors or subcontractors during any period of debarment, suspension, or placement
in ineligibility status.
(Signature)* (Date)
(Title)*
*If signed by anyone other than board chairperson, please attach a resolution of the board authorizing
the signatory.
59
NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE
Bureau of Housing and Shelter Services
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA) PROGRAM
2009 APPLICATION
J. CERTIFICATION OF LOCAL APPROVAL
I, ,
(Name) (Title)
of , duly authorized to act on
(Name of the agency in which the local signator serves
behalf
of hereby approve the project proposed by
(Name of Jurisdiction)
to undertake eligible activities under the
(Name of Project Sponsor Organization)
Housing Opportunities for Persons with AIDS (HOPWA) program.
(Signature) (Date)
60
ATTACHMENT A
HOPWA REGULATIONS
61
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