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Backup Documents 04/14/2026 Item #16D 2ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D 2 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines # 1 through #2 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the exce tion of the Chairman's signature, draw a line through routing lines # 1 through #2, complete the checklist, and forward to the County omey Office. Route to Addressees (List in routing order) Office Initials Date 1. Jennifer Lofendo Community and Human JL 4/9/26 Services 2. County Attorney Office — CLD County Attorney Office \ h 3. BCC Office Board of County Commissioners 4. Minutes and Records Clerk of Court's Office S►� y1i5 PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above, may need to contact staff for additional or missing information. Name of Primary Staff Jennifer Lofendo, CHS Grants Coordinator Phone Number 252-2593 Contact / Department Agenda Date Item was 4/14/26 Agenda Item Number 16.13.2 Approved by the BCC Type of Document FIRST AMENDMENT TO AGREEMENT Number of Original 3 Attached BETWEEN COLLIER COUNTY AND THE Documents Attached SHELTER FOR ABUSED WOMEN & CHILDREN, INC. PO number or account number if document is to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is Yes N/A (Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature. JL 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A rovide the Contact Information Name; Agency; Address; Phone on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be JL signed by the Chairman, with the exception of most letters, must be reviewed and signed bv the Office of the County Attorney. 4. All handwritten strike -through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A document or the final negotiated contract date whichever is applicable. 6. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's JL signature and initials are required. 7. In most cases (some contracts are an exception), the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on above date and all changes made during N/A is not the meeting have been incorporated in the attached document. The County & �� an option for Attorne 's Office has reviewed the changes, if applicable. (� this line. 9. Initials of attorney verifying that the attached document is the version approved by the N/A is not BCC, all changes directed by the BCC have been made, and the document is ready for the co an option for Chairman's signature. I this line. 1 6 D 2 FAIN # E-25-UC-120016 Federal Award Date EST 10/2025 Federal Award Agency HUD CFDA Name Emergency Solutions Grant CFDA/CSFA# 14.231 Total Amount of Federal Funds Awarded $65,000.00 $95,000.00 Subrecipient Name The Shelter for Abused Women & Children, Inc. UEI# FJA 1 VKEREQFA FEIN 59-2752895 R&D No Indirect Cost Rate No Period of Performance Oeteber- 1 5 January 6, 2026 - September 30, 2026 Fiscal Year End June 30 Monitor End: December 2026 FIRST AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY AND THE SHELTER FOR ABUSED WOMEN & CHILDREN, INC. Shelter Operations Program THIS AMENDMENT is made and entered into this fL day of2026, by and between Collier County, a political subdivision of the State of Florida, (COUNTY) having its principal address as 3339 Tamiami Trail East, Suite 213, Naples, FL 34112, and THE SHELTER FOR ABUSED WOMEN & CHILDREN, INC., a private not -for -profit corporation existing under the laws of the State of Florida, (SUBRECIPIENT) having its principal office at P.O. Box 10102, Naples, FL 34101. WHEREAS, the COUNTY is an entitlement community of the United States Department of Housing and Urban Development (HUD) for a grant to execute and implement the Emergency Solutions Grant (ESG) program in certain areas of Collier County, pursuant to the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act (24 CFR 576) amending the McKinney-Vento Homeless Act (42 U.S.C. 11371-11378); and WHEREAS, pursuant to the aforesaid grant, COUNTY is undertaking certain activities to primarily benefit homeless individuals in Collier County with the use of ESG funds to improve the quality of life in Collier County by providing assistance for any of the following five (5) program components: street outreach, emergency shelter, homelessness prevention, rapid re -housing assistance, and Homeless Management Information System (HMIS); and WHEREAS, the Board of County Commissioners of Collier County (Board) approved the Collier County Consolidated Plan - One -Year Action Plans for Federal Fiscal Year 2025-2026 for the ESG Program at the July 8, 2025, Board of County Commissioners meeting, Agenda Item 16.13.2; and WHEREAS, in accordance with HUD regulations and the Collier County Consolidated Plan concerning the 2025, preparation of various Annual Action Plans, the COUNTY advertised the 2025 — 2026 SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT # 1 ES25-01 Shelter Operations Page 1 CAO 1 6 0211 Annual Action Plan, on May 22, 2025, with a 30-day Citizen Comment period from June 6, 2025, to July 6, 2025; and WHEREAS, on October 14, 2025, Agenda Item 16.13.7, the COUNTY entered into an Agreement (the "Agreement") with SUBRECIPIENT which set forth the responsibilities and obligations of each in undertaking the Emergency Solutions Grant Project - (ES25-01) Shelter Operations Program: and WHEREAS, the parties wish to amend the agreement, incorporated herein by reference, to increase the project budget to cover additional Shelter Operating Expenses and Personnel Salaries, update Period of Performance, update the County Grants Coordinator contact, revise Grant and Special Conditions, revise Grant Control Requirements, revise Terms and Conditions, and revise General Provisions. NOW, THEREFORE, in consideration of foregoing Recitals and other good and valuable consideration, the receipt and sufficiency of which is hereby mutually acknowledged, the parties agree to amend the Agreement as follows: Words Strueli Threegl} are deleted; Words Underlined are added. PART I SCOPE OF SERVICES 1.1 GRANT AND SPECIAL CONDITIONS A. SUBRECIPIENT must submit the following resolutions or policies within sixty (60) days of the execution of this Agreement. For policies that were established more than three (3) years prior to the date of this Agreement. SUBRECIPIENT must also Drovide the date of the last review for each policy. N Fair Housing Policy N Affirmative Action/Equal Opportunity Policy N Conflict of Interest Policies (COI) and related Forms N Procurement Policy ❑ Uniform Relocation Policy N Sexual Harassment Policy N Section504/ADA Policy N Fraud, Waste, and Abuse Policy N Violence Against Women Act (VAWA) Policy N Language Assistance and Planning Policy (LAP) N Limited English Proficiency Policy (LEP) El Nevef Centraet with the Enemy Ceffifie4iea N Drug -Free Workplace Policy N Grievance Policy staff and clients) N Termination Policy (staff and clients) N Confidentiality Policy SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT # 1 ES25-01 Shelter Operations Page 2 CPU I 6D2. 1 ® Whistleblower Policy ® Record Retention Policy ® ® Monitoring Policy Ethics Policy B. Conflict of Interest — SUBRECIPIENT must have written conflict of interest policies. The Centi. utif., .,FCafe (!"'eC) E ESG Programs distinguishes between two types of conflict of interest: one related to organizations that carry out the project (recipients or subrecipients), and another specific to individuals involved in providing services and day-to-day project operations. SUBRECIPIENT shall have written policies related to both types of conflicts of interest. With respect to the use of ESG funds to procure services, equipment, supplies, or other property, the SUBRECIPIENT shall comply with 2 CFR part 200.318, 24 CFR 576.404, and all state and County statutes regulations ordinances or resolutions governing conflicts of interest. With respect to all other decisions involving the use of ESG funds, the following restrictions shall apply: No person who is an employee, agency consultant, officer, or elected or appointed official of the SUBRECIPIENT and who exercises or has exercised any functions or responsibilities with respect to assisted activities, or who is in a position to participate in a decision -making process or gain inside information with regard to such activities, may obtain a personal or financial interest or benefit from the activity, or have an interest in any contract, subcontract, or agreement with respect thereto, or the process thereunder, either for himself or herself or for those with whom he or she has family or business ties, during his or her tenure for one year thereafter. If a conflict or a potential or perceived conflict of interest is to occur, the SUBRECIPIENT must contact the COUNTY to determine whether an exception will be allowed as prescribed by the applicable federal regulations. In addition SUBRECIPIENT will not employ or subcontract any person having any conflict of interest SUBRECIPIENT covenants that it will comply with all Federal Conflict of Interest 2 CFR 200.318, and State and County statutes, regulations, ordinances, or resolutions governing conflicts of interest. All SUBRECIPIENT personnel who work on activities associated with this Agreement shall complete the Subrecipient/DeveloperNendor Conflict of Interest Disclosure Form prior to execution of this Agreement. Any employees hired later, during the period of performance for this Agreement who will work on activities associated with this Agreement shall also complete and submit to the COUNTY the Conflict of Interest Disclosure Form. SUBRECIPIENT will notify the COUNTY in writing and seek COUNTY approval prior to entering into anycontractwith an entity owned in whole or in part by a covered person, or an entity owned or controlled in whole or in part by the SUBRECIPIENT. The COUNTY max review the proposed contract to ensure that the contractor is qualified, and the costs are reasonable Approval of an identity of interest contract will be in the COUNTY'S sole discretion This provision is not intended to limit SUBRECIPIENT'S ability to self -manage the projects using its own employees. SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #I ES25-01 Shelter Operations Page 3 CAO 1 6 D 2 Ewe 1$1 1.2 PROJECT DETAILS A. Project Description/Budget The budget identified for the Shelter Operations Program shall be as follows: Description Federal Amount ESG Cost Sharing 1:1 Project Component 1: General Shelter Operating Expenses $65,000.00 $65,000.00 and Personnel Salaries include but are not limited to: $95,000.00 $95,000.00 Recurring monthly expenses such as equipment rental, security personnel, security system monitoring fees, internet, phone, electricity, water and sewer, trash collection, property insurance and lawn care. Maintenance and management expenses such as pest control, appliance repair, plumbing repair, lighting, landscaping, security and professional services. Supply expenses such as toiletries, linens, cleaning supplies, paper products and food costs for the shelter; staff salaries. ESG Cost Sharing Requirement Documentation of $65,000.00 ESG Eligible Cost $95,000.00 Sharing Funds Total Federal Funds: 00�80 $95,000.00 SUBRECIPIENT will accomplish the following checked project tasks: ❑ Pay all closing costs related to property conveyance ® Maintain and provide to the COUNTY, as requested, beneficiary documentation that supports the benefit of homelessness ® Provide Quarterly Reports on project progress ❑x Provide Quarterly Report from HMIS or HUD Approved Comparable Reporting System x❑ Ensure attendance by a representative from executive management at quarterly partnership meetings, as requested by CHS ❑ Provide monthly construction and rehabilitation progress reports until completion of construction or rehabilitation ❑ Identify Lead Project Manager ❑ Provide Site Design and Specifications ❑ Submit Change Orders for CHS approval prior to SUBRECIPIENT authorizing work ❑ Comply with Davis -Bacon Labor Standards and maintain supporting documentation ❑ Provide certified payroll weekly throughout construction and rehabilitation ❑ Comply with Section 3 reporting requirements and maintain supporting documentation ❑ Comply with Uniform Relocation Act (URA), if applicable ❑ Ensure applicable numbers of units are Section 504/ADA accessible ❑ Ensure the applicable affordability period is met for the project SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 4 CAO C. Performance Deliverables Program Deliverable Deliverable Supporting Submission Schedule Documentation Insurance Insurance Certificate Within 30 days of Agreement execution and annually within thirty (30) days of renewal Special Grant Condition Policies as stated in this Within sixty (60) days of Policies Section 1.1 Agreement Agreement execution Project Plans and Site Plans and Specifications N/A Specifications Procurement Documents (Bid Independent Cost Estimate N/A Packet)* Method of Procurement Solicitation Packet, including Conflict of Interest, No Enemy Contract, Trafficking, and Whistleblower Forms. Subcontractor Log Subcontractor Log N/A Quarterly Progress Report Exhibit C 1. Quarterly, within 10 days after the end of the quarter 2. Final report upon submission of final pay request. Quarterly Report from HMIS HMIS or HUD Approved Quarterly, within 10 days after the or HUD Approved Comparable System Report end of each quarter. Final report due Comparable Database 60 days after Agreement ends. Fair Housing Calls Report Fair Housing Call Log Quarterly, within 10 days following the end of the quarter. Final report due upon submission of the final pay request in Nei hborl . Annual Audit Monitoring Exhibit D Annually, within 60 days after FY Report end Financial and Compliance Audit, Management Letter and Annually, nine (9) months for Audit Supporting Documentation Single Audit OR one hundred and eighty (180) days after FY end. Program Income Reuse Plan Plan Approved by the N/A COUNTY Collier County Inventory Exhibit I Annually, within 60 days after FY Form end r f intefest Fe .Y. Genfliet ef Interest Diseles FefmExhibit M Upon execution of the Agreement, all employees who work on activities associated with the grant and upon hiring of all new .diet e Subrecipient/Developer/ Vendor Conflict of Interest Form Employees who will work on activities associated with the grant. Whistleblower Protections Exhibit J Upon execution of the Agreement, Certification_— all employees who work on Subrecipient Staff activities associated with the grant and u on hirin of all new SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 5 CAO 16D2 employees who will work on activities associated with the arant Affidavit Regarding Labor and Services(Trafficking) A ff�:t.- Exhibit N Upon execution of the Agreement and with each amendment thereafter. Never Contract with the Enem Certification Exhibit O Upon execution of the Agreement. Certification of Drug -Free Exhibit K Within 30 days of Agreement execution. Work lace Anti -Discrimination, Fair Exhibit L Within 30 da sy of Agreement execution. Housing, and Equal Qppprtuniiy Certification Consent to Verify Immigration Status SAVE Exhibit P N/A D. Payment Deliverables Payment Deliverable Payment Supporting Documentation Submission Schedule Project Component 1: General Exhibit B and backup documentation Monthly payment Shelter Operating Expenses and including but not limited to properly requests due within 30 Personnel Salaries include but completed invoices, canceled checks/wire days of the prior month are not limited to: Recurring confirmations, i-Mi-Aeeuments(s), or any end monthly expenses such as additional supporting documentation as equipment rental, security needed personnel, security system monitoring fees, internet, phone, electricity, water and sewer, 10% retainage will be deducted from each trash collection, property invoice insurance and lawn care. Maintenance and management Final 10-0,; expenses such as pest control, aeeti.f,,,. tati benefieiafies n of se ed an appliance repair, plumbing repair, lighting, landscaping, security and professional services. Supply expenses such as toiletries, linens, cleaning supplies, paper products and food costs for the shelter; staff salaries. ESG Cost Sharing Exhibit 13-1, along with supporting Cost Monthly Cost Sharing documentation Sharing: a minimum of dollar -for -dollar, with each submitted pay request. The Ffinal 10 percent retainaof the award amount will be paid upon completion of documentation of all beneficiaries, satisfaction of match obli ag tion and final monitoring clearance. SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. ES25-01 Shelter Operations Page 6 AMENDMENT#1 CAC 1D 1.3 PERIOD OF PERFORMANCE SUBRECIPIENT services shall start on Oetebei T20 January 6, 2026, and end on September 30, 2026 (Term of Agreement). SUBRECIPIENT's services/activities shall be undertaken and completed considering the purposes of this Agreement. Any Funds not obligated by the expiration date of this Agreement shall automatically revert to the COUNTY. The County Manager or designee may extend the term of this Agreement for a period of up to 180 days after the end of the Agreement following receipt of SUBRECIPIENT's written request submitted at least 30 days prior to agreement period of performance end date. Extensions must be authorized, in writing, by formal letter to SUBRECIPIENT. 1.4 AGREEMENT AMOUNT The COUNTY agrees to make available SLXT-V FIVE THOUSAND DOLLARS AND ZE CENTS ($65,000.00) NINETY-FIVE THOUSAND DOLLARS AND ZERO CENTS ($95,000.00) for use by SUBRECIPIENT during the Term of the Agreement (hereinafter referred to as the Funds). 1.7 NOTICES Notices required by this Agreement shall be in writing and delivered via mail (postage prepaid), commercial courier, personal delivery, facsimile, or other electronic means. Any notice delivered or sent as aforesaid shall be effective on the date of delivery or sending. All notices and other written communications under this Agreement shall be addressed to the individuals in the capacities indicated below, unless otherwise modified by subsequent written notice. COLLIER COUNTY ATTENTION: dfiefino,► eije. Jennifer Lofendo, Grants Coordinator I Collier County Government Community and Human Services Division 3339 Tamiami Trail East, Suite 213 Naples, Florida 34112 Email: Jennifer.Lofendo(2collier. gov Telephone: (239) 252-5229 SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 7 16D2� SUBRECIPIENT ATTENTION: Linda Oberhaus, Chief Executive Officer The Shelter for Abused Women and Children P.O. Box 10102 Naples, FL 34101 Email: Loberhausg_naplesshelter.org Telephone: (239) 280-1350 PART II GRANT CONTROL REQUIREMENTS 2.2 RECORDS AND DOCUMENTATION D. Upon completion of all work contemplated under this Agreement, copies of all documents and records relating to this Agreement shall be surrendered to CHS, if requested. In any event, SUBRECIPIENT shall keep all documents and records in an orderly fashion and in a readily accessible, permanent, and secured location for five (5) years after the date of COUNTY'S submission of the final performance and evaluation report (CAPER) to HUD, as prescribed in 24 CFR 576.500(y). However, if any litigation, claim, or audit is started before the expiration date of the five (5) year period, the records will be maintained until all litigation, claim, or audit findings involving these records are resolved. If SUBRECIPIENT ceases to exist after closeout of this Agreement, it must notify the COUNTY in writing, of the address where the records are to be kept, as outlined in 2 CFR 200.337. SUBRECIPIENT shall meet all requirements for retaining public records and transfer, at no cost to the COUNTY, all public records in SUBRECIPIENT's possession upon termination of the Agreement and destroy any duplicate, exempt, and/or confidential public records that are released from public records disclosure requirements. All records stored electronically must be provided to the COUNTY in a format that is compatible with the COUNTY's information technology systems. IF SUBRECIPIENT HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 1199 FLORIDA STATUTES, TO THE SUBRECIPIENT'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, IT SHALL CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT 239- 252-58379 Angel.Peralancollier.gov, 3299 Tamiami Trail East, Naples, FL 34112. E. SUBRECIPIENT shall establish and maintain ineeme eligible files on clients served, and documentation that all households clients are eligible under HUD Income Guidelines. Client files will be reviewed for compliance at interim and/or closeout monitoring. SUBRECIPIENT agrees that CHS shall be the final arbiter on SUBRECIPIENT's SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 8 C9� I 6 D 2--1 compliance. F. SUBRECIPIENT shall document how it complied with the Program Component(s), as defined in 24 CFR 576.100, and the eligibility requirement(s) under which funding has been received. This includes special requirements such as necessary and appropriate determinations, as defined in 24 CFR 576.100; income certification; and written agreements with beneficiaries, where applicable. G. Not Applicable for this Proiect In accordance with Section 214 of the Housing and Communily Development Act and applicable HUD guidance, SUBRECIPIENT shall be responsible for completing Systematic Alien Verification for Entitlements (SAVE) verification for all program beneficiaries prior to provision of HUD -funded assistance. SUBRECIPIENT must ensure that each assisted household member, includina all children and adult household members must meet eligible immigration status requirements. SUBRECIPIENT shall obtain client consent from each household member to verify immigration status using the Consent to Verify Immigration Status form (Exhibit P). The consent form and documentation of SAVE confirmation must be maintained in the client file. No funds may be expended for any beneficiary until SAVE eligibility has been verified and properly recorded SUBRECIPIENT shall retain all verification records in compliance with federal state and local record -keeping requirements and make such documentation available for monitoring or audit upon request. H. SUBRECIPIENT is encouraged to engage in efforts to assure compliance with the Fair Housing Act 42 U.S.C. 3601 et. se through Fair Housing activities offered to real estate brokers the general ublic and other interested parties,• and to track and report Fair Housing calls received SUBRECIPIENT shall establish a system to log all Fair Housing calls. The s stem must track the nature of the calls,• actions taken in response to the calls-, results of the actions taken and if the caller was referred to another agency, the results obtained by the referral agency. SUBRECIPIENT must submit this call log to CHS quarterly, no later than 10 calendar days after the end of each quarter. C- I. SUBRECIPIENT shall provide the public with access to public records on the same terms and conditions that the COUNTY would provide the records, and at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes or as otherwise provided by law. SUBRECIPIENT shall ensure that exempt or confidential public records that are released from public records disclosure requirements are not disclosed, except as authorized by 2 CFR 200.337 and 2 CFR 200.338. J. SUBRECIPIENT shall take reasonable cybersecurity and other measures to safeguard information including protected personally identifiable information (PII) and other types of information in accordance with 2 CFR 200.303(e). This includes information that HUD or the COUNTY designates as sensitive, or other information the COUNTY considers sensitive and is consistent with applicable Federal, State, and Local laws regarding privacy and responsibility over confidentiality. PART III TERMS AND CONDITIONS SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 9 CAO 16D2 3.13 PURCHASING SUBRECIPIENT is required to follow Federal Procurement standards at (2 CFR 200.318 through 200.327) and Collier County's Procurement Ordinance #2017 08 2025-34. A conflict between Federal and COUNTY requirements will result in the more stringent law being applied Current purchasing thresholds are: uired $0 $30,000 ILQ M01 - $50,000 3 Written Quotes or via the COUNTY'S bidding Ip atfo $50,001 4- $50,001 - $250,000 Fafmal Selieita4ien (ITB RFD, ) 3 Quotes through COUNTY'S bidding platform $250.001+ Fnrmal Cnlinirorinn (TTT2 DUD o+.. \ All improvements specified in Part I Scope of Services shall be performed by SUBRECIPIENT employees, or be put out to competitive bidding, under a procedure acceptable to the COUNTY and Federal requirements. SUBRECIPIENT shall enter into contracts with the lowest, responsible, and qualified bidder. Contract administration shall be conducted by SUBRECIPIENT and monitored by CHS, which shall have access to all records and documents related to the project. • SUBRECIPIENT shall pfeetife predtiets, similaf te finefgy Star- and Wa4ef Sense pr-eduets nYY s' theA ifiereaseuse of SUBRECIPIENT shall comply with 2 CFR Part 200 procurement standards and all applicable ESQ habitability and environmental requirements under 24 CFR Part 576 In accordance with 2 CFR 200.323, SUBRECIPIENT shall procure items that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of completion, per 2 CFR 200, Appendix II (J) and 2 CFR 200.323. 3.16 OPPORTUNITIES FOR RESIDENTS AND CIVIL RIGHTS COMPLIANCE SUBRECIPIENT agrees that no person shall be excluded from the benefits of or be subjected to discrimination under any activity carried out by the performance of this Agreement based on race, color, disability, national origin, religion, age, familial status, or sex. The COUNTY will monitor SUBRECIPIENT policies and practices throughout the term of the Agreement and affordability period. Upon receipt of evidence of such discrimination, the COUNTY shall have the right to terminate this Agreement. 3.19 AFFIRMATIVE ACTION PLAN SUBRECIPENT agrees that it is committed to carrying out an Affirmative Action Program, pursuant to COUNTY'S specification, in keeping with the principles as provided in Executive Order 11246 of September 24, 1966. Priebe the ar; a -•a of Funds, S B ECIPENT shall submit SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT # 1 ES25-01 Shelter Operations Page 10 CAO 16D2 must be , of , SUBRECIPIENT shall post a notice of its commitment to following Affirmative Action requirements in conspicuous places available to all employees and applicants for employment. SUBRECIPIENT'S contractingofficer will also send this notice to each labor union or representative of worker with which it has a collective bargaining agreement or other contract or understanding, advising the labor union or worker's re resentative of SUBRECIPIENT'S commitments hereunder. .._ _jil " .._ "- - NE JIFIN VA PANIAT-1 - _ \. s 14111 moll- _ - \ e \ ~11 NO SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 11 C'A O 16D2 4 o-1 III ir&W 3:24 3.20 EMERGENCY SHELTERS Any emergency shelter that receives assistance for shelter operations must also meet minimum safety, sanitation, and privacy standards (Exhibit E), as required by 24 CFR 576.403(b). 3423.21 PERMANENT HOUSING Housing that program participants who receive ESG assistance to remain or move into must meet the minimum habitability standards (Exhibit F) provided in 24 CFR 576.403(c) and all applicable State and Local housing codes, licensing requirements, and any other requirements in the jurisdiction in which the housing is located regarding the condition of the structure and the operation of the housing. 3:�3 3.22 COORDINATION WITH CONTINUUM OF CARE AND OTHER PROGRAMS SUBRECIPIENT must document its compliance with the requirements of 24 CFR 576.400(a) for consulting with the Continuum of Care and coordinating and integrating ESG assistance with programs targeted toward homeless people and mainstream service and assistance programs (Exhibit G). 3-.24 3.23 HOMELESS PARTICIPATION SUBRECIPIENT must document its compliance with homeless participation requirements under 24 CFR 576.405(c). 3453.24 BYRD ANTI -LOBBYING AMENDMENT The COUNTY, SUBRECIPIENT, and their contractors certify that they will not, and have not, used Federally appropriated Funds to pay any person or organization for influencing or attempting to influence the award of Federal Funds, as covered by 31 USC 1352, and more fully described in Section 4.53 of this Agreement. Contractors who apply or bid for an award of $100,000 or more shall file the required certification. 3-.26 3.25 CENTRALIZED OR COORDINATED ASSESSMENT SYSTEMS AND PROCEDURES SUBRECIPIENT must maintain documentation evidencing the use of and written intake procedures for the centralized or coordinated assessment system(s) developed by the Continuum of Care, in accordance with the requirements established by HUD and identified in 24 CFR 576.500(g). 3473.26 CONDITIONS FOR RELIGIOUS ORGANIZATIONS ESG Funds may be used by religious organizations or on property owned by religious organizations SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT # 1 ES25-01 Shelter Operations Page 12 CAG 1 6 D 2 only in accordance with requirements set in Section 24 CFR 576.406. SUBRECIPIENT shall comply with First Amendment Church/State principles as follows: A. It will not discriminate against any employee or applicant for employment and will not limit or give preference in employment to persons based on religion. B. It will not discriminate against any person applying for public services and will not limit such services or give preference to persons based on religion. C. It will retain its independence from Federal, State, and Local governments and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided that it does not use direct ESG Funds to support any inherently religious activities, such as worship, religious instruction, or proselytizing. D. The Funds shall not be used for the acquisition, construction, or rehabilitation of structures to the extent that those structures are used for inherently religious activities. Where a structure is used for both eligible and inherently religious activities, ESG Funds may not exceed the cost of those portions of the acquisition, construction, or rehabilitation that are attributable to eligible activities in accordance with the cost accounting requirements applicable to ESG Funds in this part. Sanctuaries, chapels, or other rooms that an ESG Funded religious congregation uses as its principal place of worship, however, are ineligible for ESG Funded improvements. 3-.28 3.27 INCIDENT REPORTING If SUBRECIPIENT provides client services under this Agreement, SUBRECIPIENT and any of its subcontractors shall report to the COUNTY knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled person. During the term of this Agreement, SUBRECIPIENT must report to the COUNTY in writing, within one business day of occurrence, any substantial, controversial, or newsworthy incidents. The Collier County Incident Report Form (Exhibit H) shall be used to report all such incidents. 3.29 3.28 DUPLICATIAON OF EFFORT SUBRECIPIENT certifies that costs for work to be performed under this Agreement and any subcontract do not duplicate any costs charged against any other contract, subcontract, or other source, in accordance with 48 CFR 1331.205-70. SUBRECIPENT agrees to advise the COUNTY in writing of any other contract or subcontract it has performed or is performing which involves work directly related to the purpose of this Agreement. 3.30 3.29 SEVERABILITY Should any provision of the Agreement be determined to be unenforceable or invalid, such determination shall not affect the validity or enforceability of any other section or part thereof. &M 3.30 MISCELLANEOUS SUBRECIPIENT and COUNTY each binds itself, its partners, successors, legal representatives, and assigns of such other party in respect to all covenants of this Agreement. SUBRECIPIENT represents and warrants that the financial data, reports, and other information it furnished to the COUNTY regarding the Project are accurate and complete, and financial disclosures fairly represent the financial position of SUBRECIPIENT. SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 13 CAO 16D2 SUBRECIPIENT understands that client information collected under this Agreement is private and the use or disclosure of such information, when not directly connected with the administration of the COUNTY'S or SUBRECIPIENT's responsibilities with respect to services provided under this Agreement, is prohibited unless written consent is obtained from such person receiving service and, in case of a minor, that of a responsible parent/guardian. SUBRECIPIENT certifies that it has the legal authority to receive the Funds under this Agreement and its governing body has authorized the execution and acceptance of this Agreement. SUBRECIPIENT also certifies that the undersigned person has the authority to legally execute and bind the SUBRECIPIENT to the terms of this Agreement. The section headings and subheadings contained in this Agreement are included for convenience only and shall not limit or otherwise affect the terms of this Agreement. The Grant Documents shall be construed in accordance with and governed by the laws of the State of Florida, without giving effect to its provisions regarding choice of laws. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. All activities authorized by this Agreement shall be subject to and performed in accordance with the provisions of the terms and conditions of the Agreement between the COUNTY, the Regulations, all applicable Federal, State, and Municipal laws, ordinances, regulations, orders, and guidelines, including but not limited to any applicable regulations issued by CHS. Electronic Signatures. This Agreement, and related documents entered into in connection with this Agreement, are signed when a party's signature is delivered by facsimile, e-mail, or any other electronic medium. These signatures must be treated in all respects as having the same force and effect as original signatures. 3-.32 3.31 WAIVER The COUNTY'S failure to act with respect to a breach by SUBRECIPIENT does not waive its right to act with respect to subsequent or similar breaches. The COUNTY'S failure to exercise or enforce any right or provision shall not constitute a waiver of such right or provision. PART IV GENERAL PROVISIONS 4.4 Title VI of the Civil Rights Act of 1964 as amended, https://www.hud.gov/programdescription/title6 Title VIII of the Civil Rights Act of 1968, as amended Executive Order 14173• (Amends/Revokes E O 12898 13583, 13672 11478 11246 and Presidential Memorandum dated October 15 2016) E O 14173 prohibits consideration of race, color, sex sexual preference religion or national origin in ways that violate federal civil rights SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 14 CAO 16 a2 laws (promoting diversity and inclusion in the workforce). https //www federalre isg ter ov/documents/2025/01/31/2025-02097/ending-illegal_ di scrimination-and-restori np,-merit-based-opportunity 4.8 24 CFR 75 — Regulations outlining requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended. Compliance with the provisions of Section 3 of the HUD Act of 1968, as amended, and as implemented by the regulations set forth in 24 CFR 75, and all applicable rules and orders issued hereunder prior to the execution of this Agreement, shall be a condition of the Federal financial assistance provided under this Agreement and binding upon the COUNTY, the SUBRECIPIENT and any of the SUBRECIPIENT's Subrecipients and subcontractors. Failure to fulfill these requirements shall subject the COUNTY, the SUBRECIPIENT and any of the SUBRECIPIENT's Subrecipients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through which Federal assistance is provided. The SUBRECIPIENT certifies and agrees that no contractual or other disability exists that would prevent compliance with these requirements. eCFR 24 CFR Part 75 Economic Opportunities for Low- and Very Low -Income Persons SUBRECIPIENT further agrees to comply with these "Section 3" requirements and to include the following language in all subcontracts executed under this Agreement: "The work to be performed under this Agreement is a project assisted under a program providing direct Federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701). Section 3 requires that, to the greatest extent feasible, opportunities for training and employment be given to low- and very low-income residents of the project area, and that contracts for work in connection with the project be awarded to business concerns that provide economic opportunities for low- and very low-income persons residing in the metropolitan area in which the project is located." Section 3 requires 25 percent of the total labor hours must be worked by Section 3 workers and 5 percent of the total labor hours must be worked by Targteted Section 3 workers. If the SUBRECIPIENT is unable to meet these benchmarks, efforts taken to meet the requirements must be described Examples include holding job fairs, conducting on-the-4ob traimn2, outreach efforts to public housing residents, and connecting residents to supportive services. The Section 3 Neighborhood and Service Area tool identifies the geographic boundaries of a neighborhood or service area that includes Targeted Section 3 workers employed on a Section 3 project. The tool assists Section 3 funding recipients, subrect cents contractors and subcontractors to determine the service area or neighborhood of a HUD -funded Section 3 project The tool can be found online at the followin link. hudexchange.us5.list- mana e.com/track/click?u=87d7c8afc03ba69ee70d865b9&id=57e1Oc9915&e=c09c40af84 SUBRECIPIENT further agrees to ensure that opportunities for training and employment arising in connection with a housing rehabilitation (including reduction and abatement of lead -based paint hazards), housing construction, or other public construction project are given to low- and very low- income persons residing within the metropolitan area in which the ESG-funded project is located; where feasible, priority should be given to low- and very low-income persons within the service area of the project or the neighborhood in which the project is located, and to low- and very low - SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT # 1 ES25-01 Shelter Operations Page 15 Ck 1 6 D2 income participants in other HUD programs; and award contracts for work undertaken in connection with a housing rehabilitation (including reduction and abatement of lead- based paint hazards), housing construction, or other public construction project to business concerns that provide economic opportunities for low- and very low-income persons residing within the metropolitan area in which the ESG-funded project is located; where feasible, priority should be given to business concerns that provide economic opportunities to low- and very low-income residents within the service area or the neighborhood in which the project is located, and to low - and very low-income participants in other HUD programs. https://www.hud.gov/sites/documents/DOC 12047.PDF SUBRECIPIENT certifies and agrees that no contractual or other legal incapacity exists that would prevent compliance with these requirements. littps://www.ecfr.gov/current/title-24/subtitle-A/part-75 4.24 Immigration Reform and Control Act of 1986 https://www.eeoc-gov/eeoc/history/3 5th/thelaw/irca.html Personal Responsibility and Work Opportunity Reconciliation Act or 1996 (PRWORA). This act exempts non-profit charitable organizations from verifying an applicant's immigration status when gpplying for federal benefits 8 U.S.C. § 1642 d . https://www. law.cornell.edu/uscode/text/8/1642 4.43 Equal Treatment of Faith -Based Organizations: By regulation, HUD prohibits all recipient organizations from using financial assistance from HUD to fund explicitly religious activities. SUBRECIPIENT agrees to avoid such prohibited conduct. For more information, see https://ojp.gov/about/ocr/partnerships.hti-n. Discrimination based on religion in employment is generally prohibited by federal law, but the Religious Freedom Restoration Act is interpreted on a case -by -case basis to allow some faith -based organizations to receive HUD funds while taking into account religion when hiring staff. Questions in this regard should be directed to the Office for Civil Rights. A. Organizations that are religious or faith -based are eligible, on the same basis as any other organization, to participate in ESG. B. The Subrecipient may not engage in inherently religious activities, such as worship, religious instruction, or proselytization as part of the programs or services funded under ESG. If the Subrecipient conducts such activities, the activities must be offered separately, in time or location, from the programs or services funded under ESG, and participation must be voluntary for the program participants. In addition all accounting for such activities must be kept separate from any inherently religious activities. C. A religious Subrecipient that receives ESG funding will retain its independence from Federal, State, and local governments, and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided that it does not use direct ESG funds to support any inherently religious activities, such as worship, religious instruction, or proselytization. Among other things, faith -based Subrecipients may use space in their facilities to provide ESG funded services, without removing religious art, icons, scriptures, or other religious symbols. In addition, a Subrecipient retains its authority over its internal governance, and it may retain religious terms in its name, select its board members on a SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 16 CAI 1 6D2 religious basis, and include religious references in its mission statements and other governing documents. D. The Subrecipient that participates in ESG shall not, in providing program assistance, discriminate against a program participant or prospective program participant on the basis of religion or religious belief. E. If the Subrecipient voluntarily contributes its own funds to supplement federally funded activities, the Subrecipient has the option to segregate the federal funds or commingle them. However, if the funds are commingled, the requirements listed above apply to all of the commingled funds. 1. Exhibit B is hereby amended as set forth in Exhibit B attached hereto and incorporated herein. 2. Exhibit B-1 is hereby amended as set forth in Exhibit B-1 attached hereto and incorporated herein. 3. Exhibit C is hereby amended as set forth in Exhibit C attached hereto and incorporated herein. 4. Exhibit J is hereby amended as set forth in Exhibit J attached hereto and incorporated herein. 5. Exhibit K is hereby attached and incorporated herein. 6. Exhibit L is hereby attached and incorporated herein. 7. Exhibit M is hereby attached and incorporated herein. 8. Exhibit N is hereby attached and incorporated herein. 9. Exhibit O is hereby attached and incorporated herein. 10. Exhibit P is hereby attached and incorporated herein. 11. Except as set forth herein, the Agreement remains in full force and effect. Remainder of Page Intentionally Left Blank Signature Page to Follow SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT 41 ES25-01 Shelter Operations Page 17 E 6D2-401 IN WITNESS WHEREOF, the SUBRECIPIENT and COUNTY, have each, respectively, by an authorized person or agent, hereunder set their hands and seals on the date first written above. ATTEST: CRYSTAL K. KINZEL, CLERK eputy Clerk n � ' Z� WI Witness # I Signature Witness # I Printed Name S1Ct�� 12l�tiMC9� Witness #2 Signature ste mole eOxt06 Witness 42 Printed Name Approved as to form and legality: /ir4baD Courtney L. DaSilva Assistant County Attorney 3jglZG Date: t4l I q 1 .ii AS TO COUNTY: BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA By: / - KOWAL, C AIRPERSON Date: AS TO SUBRECIPIENT: THE SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. By:� LINI11► E CUS, CHIEF EXECUTIVE OFFICER Date: 3 — 1 0. 21..( [Please provide evidence of signing authority] SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT # 1 ES25-01 Shelter Operations Page 18 CAO 16D2 EXHIBIT B COLLIER COUNTY COMMUNITY & HUMAN SERVICES SECTION I: REQUEST FOR PAYMENT SUBRECIPIENT Name: The Shelter for Abused Women & Children, Inc. SUBRECIPIENT Address: P.O. Box 10102, Naples, FL 34101 Project Name: Shelter Operations Project No: ES25-01 Payment Request # Total Payment Minus Retainage: Period of Availability: Oeteber- 1, 20 January 6, 2026, through September 30, 2026 Period for which the Agency has incurred the indebtedness through SECTION II: STATUS OF FUNDS Subrecipient CHS Approved 1. Grant Amount Awarded $ 95 000.00 2. Total Amount of Previous Requests $ $ 3. Amount of Today's Request (Total expenditures $ $ this period minus retaina e, if applicable) 4. Current Grant Balance (Grant Amount minus $ $ previous requests minus today's request) By signing this report, I certify to the best of my knowledge and belief that the information contained in this report is true, complete and accurate. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise (U.S. Code Title 18, Sections 2, 1001, 1343 and Title 31, Sections 3729-3730 and 3801-3812). Signature Title Authorizing Grant Coordinator Supervisor (Approval required $14,999 and below) Date Authorizing Grant Accountant Division Director (Approval Required $15,000 and above) SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 19 'QA U 16D2; EXHIBIT B-1 Cost Sharing Form Subrecipient Cost Sharing Submittal SECTION I: COST SHARING SUBMISSION Subrecipient Name: The Shelter for Abused Women & Children, Inc. Subrecipient Address: P.O. Box 10102 Naples, FL 34101 Project Name: Shelter Operations Project No: ES25-01!Cost Sharing Submission#: Cost Sharing Amount Submitted Today: $0.00 SECTION I: STATUS OF FUNDS 1. Total Cost Sharing Amount Required per Agreement $65,000.00 $95,000.00 2. Total Amount of Previous Cost Sharing Submitted (Insert Amount) $0.00 3. Total Cost Sharing Amount Awarded Per Agreement Less Total Amount of Previous Cost Sharing Submitted $0.00 4. Amount of Today's Cost Sharing Submission (Insert Amount) $0.00 5. Cost Sharing Balance (Cost Sharing per Agreement less the Sum of All Cost Sharing Submitted) $0.00 I cert� that this Cost Sharing Submittal has been made in accordance with the terms and conditions of the Agreement between the COUNTY and us as SUBRECIPIENT/DEVELOPER. To the best of my knowledge and belief, all grant requirements have been followed. Signature Title Authorizing Grant Coordinator Signature Supervisor Signature Date Authorizing Grant Accountant Signature Department Director Signature SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #I ES25-01 Shelter Operations Page 20 CAC 16D2 EXHIBIT C Emergency Solutions Grants (ESG) Quarterly Performance Report Subrecipient Name: The Shelter for Abused Women & Children, Inc. Report Period: Fiscal Year: Contract/Project Number: Organization/s: Project Name: Contact Name: Contact Number: ES25-01 The Shelter for Abused Women & Children, Inc. Shelter Operations Activity Reporting Period Report Due Date g > r,e on be , 4 Jmffftf�-w January 4�91 61h — March 31 s' April 101 April 1 st — June 3 00, July 10 July 1' — September 30 October 1 Otn Characteristics Report 1. Report Selection Criteria Ethnicity Quarter YTD Race Non- Hispanic Hispanic Non - Hispanic Hispanic White Black/African American Asian American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander Other/Multi-Racial 2. Number of adults and children served: a. Residential Quarter YTD Number of Adults Number of Children Number of Unknown Age b. Non -Residential Number of Adults Number of Children Number of Unknown Age SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT # I ES25-01 Shelter Operations Page 21 CAO 16D2 2 'W-1%ar of in/lividnale/families served. by categories: Quarter YTD a. Number of individual households (singles) Male Female Male Female Unaccompanied 18 and over Unaccompanied 17 and under Quarter YTD b. Number of Families with children Male Female Male Female Headed by single 18 and over Headed by single 17 and under Headed by two parents 18 and over Headed by two parents 17 and under Number of Families with no children TOTAL 4. Total ro'ect s /servicesprovided to silents in ran e: Quarter YTD a. emergency shelter facilities shelter b. vouchers for shelters c. drop -in center d. food pantry e. mental health f. alcohol/drug g. childcare h. employment i. transitional j. outreach k. soup kitchen/meal distribution 1. health care m. HIV/AIDS services n. other (please list) TOTAL e iv....,►1 nfm—*e enrvnd ti enh nnnnlatinn (duplicated count): J• l\LLlll Vll v - '---- -- - Quarter YTD a. Chronically Homeless b. Victims of Domestic Violence c. Elderly d. Veterans e. Individuals with HIV/AIDS f. Chronic Substance Abuse (alcohol and/or drug) g. Severely Mentally Ill h. Runaway / throwaway youth i. Other disability (Physical and/or Developmental) TOTAL (Chronically Homeless- HUD definition of a chronically homeless person is an unaccompanied homeless individual with a disabling condition who has either: 1) been continuously homeless for a year a more, or 2) has had at least four episodes of homelessness in the past three years.) SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT # 1 ES25-01 Shelter Operations Page 22 CAO y6D2 d. Uliients housed by shelter e: Barracks Quarter YTD Group/LargejHouse Scattered Sitpartment Single Family Detached House Single Room Occupancy Mobile Home/Trailer Hotel/Motel Other Apartment/Complex Other Single -Family Duplex Other TOTAL I hereby certify the above information is true and accurate. Signature: Printed Name: Title: Date: Your typed name here represents Your electronic signature SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 23 I 6 D211 EXHIBIT J COLLIER COUNTY COMMUNITY & HUMAN SERVICES WHISTLEBLOWER PROTECTIONS CERTIFICATION.— SUBRECIPIENT STAFF S BRECIvrORGANIZATION Name: The Shelter for the Abused Women & Children, Inc. ORGANIZATION Address: P.O. Box 10102 Employee Name: Project Name: Shelter Operations Project No: ES25-01 In accordance with 2 CFR 200.217 and 41 U.S.C. § 4712, SUBRECIvrni.r r The Shelter for the Abused Women & Children, Inc. may not discharge, demote, or otherwise discriminate against an employee in reprisal for disclosing to any of the list of persons or entities provided below, information that the employee reasonably believes is evidence of gross mismanagement of a federal contract or grant, a gross waste of federal funds, an abuse of authority relating to a federal contract or grants, a substantial and specific danger to public health or safety, or a violation of law, rule, or regulation related to a federal contract (including the competition for or negotiation of a contract) or grant. The list of persons and entities referenced in the paragraph above includes the following: • A member of Congress or a representative of a committee of Congress • An Inspector General • The Government Accountability Office • A Treasury employee responsible for contract or grant oversight or management • An authorized official of the Department of Justice or other law enforcement agency • A court or grand jury • A management official or other employee of SUBRECIPIENT, contractor, or subcontractor who has the responsibility to investigate, discover, or address misconduct SUBRECIPIEN The Shelter for the Abused Women & Children, Inc. shall inform its employees in writing of whistleblower rights and remedies provided under section 41 U.S.C. § 4712, in the predominant native language of the workforce. By signing this form, I certify that The Shelter-fef Abused `lrreft and Children ill ee_ l with I have reviewed and understand my Whistleblower rights and protections €e as provided above. Name: Signature: Title: Date: SHELTER FOR ABUSED WOMEN AND CHILDREN, INC. AMENDMENT #1 ES25-01 Shelter Operations Page 24 CAO 6D2 �1 Collier County Community & Human Services Division EXHIBIT K CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS SUBRECIPIENT Name: The Shelter for the Abused Women & Children, Inc. SUBRECIPIENT Address: Grant/Project Name: Shelter Operations Grant/Project Number: ES25-01 The SUBRECIPIENT certifies that it will provide a drug -free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing a drug -free awareness program to inform employees about— (1) The dangers of drug abuse in the workplace; (2) The SUBRECIPIENT'S policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation and employee assistance programs, and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. (c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will— (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after each conviction; (e) Notifying the agency within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted— (1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). Authorized Representative Name: Title: Signature: Date: -a Community & Human Services Division • 3339 Tamiami Trail East, Suite 213 • Naples, FL 34112-5361 • 239-252-CARE (2273) 239-252-CAFE (2233) • 239-252-5713 (RSVP) • www.collier.gov CAO 1 6D2_.�, Collier County Community & Human Services Division EXHIBIT L CERTIFICATION OF COMPLIANCE WITH ANTI -DISCRIMINATION, FAIR HOUSING, AND EQUAL EMPLOYMENT OPPORTUNITY LAWS SUBRECIPIEN Name: Oe Shelter for the Abused Women & Children, Inc. Program and Project Name IShelter Operations Grant/Contract Number: S25-01 PURPOSE As a condition of participation in programs funded or administered by Collier County, all subrecipients, contractors, developers, and vendors must comply with all applicable federal, state, and local nondiscrimination laws, rules, and regulations. This certification affirms compliance with those requirements. CERTIFICATION The undersigned certifies that, in the performance of work under this agreement, The Shelter for the Abused Women & Children, Inc. and its employees, agents, and subcontractors shall comply with non- discrimination, fair housing, and equal opportunity laws, including but not limited to: (see attachment for definitions of laws and other regulations) Federal Non -Discrimination Laws: A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq.) — prohibiting discrimination on the basis of race, color, or national origin. B. Title VII of the Civil Rights Act of 1964 — prohibiting employment discrimination based on race, color, religion, sex, or national origin. C. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794) — prohibiting discrimination based on disability. D. The Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq.). E. Title II of The Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.). F. Title IX of the Education Amendments of 1972 (20 U.S.C. § 1681 et seq.) — prohibiting discrimination based on sex. G. Section 109 of the Housing and Community Act of 1974 — prohibiting discrimination based on race, color, national origin, religion, or sex H. Section 808(e)(5) of Title VIII of the Civil Rights Act of 1968, as amended (The Fair Housing Act 42 U.S.C. § 3601 et seq.) — prohibiting discrimination in housing -related activities. 1. Housing and Community Development Act of 1974 (§ I04(b)(2), as amended and the National Affordable Housing Act (§ 105(b)(3) — Requires Affirmatively Furthering Fair Housing 2. State and Local Requirements: A. Chapter 760, Florida Statutes — Florida Civil Rights Act of 1992. B. Collier County Ordinances and policies related to equal opportunity, fair housing, and nondiscrimination in the provision of County -funded services. -S Community & Human Services Division • 3339 Tamiami Trail East, Suite 213 • Naples, FL 34112-5361 • 239-252-CARE (2273) 239- 252-CAFE (2233) • 239-252-5713 (RSVP) • www.collier.gov CAO 16D2 3. Equal Opportunity in Employment and Service Delivery: The Shelter for the Abused Women & Children, Inc] shall ensure that no person will, on the grounds of race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, familial status, or any other protected classification, be excluded from participation in, denied the benefits of, or otherwise subjected to discrimination under any program or activity receiving County funds. 4. Fair Housing: The IShelter for the Abused Women & Children, Inc agrees to take affirmative steps to ensure equal access to all programs and services and to carry out activities in a manner that supports the County's obligation to affirmatively further fair housing. The IShelter for the Abused Women & Children, Incl certifies that neither the subrecipient or its contractors have any pending or civil rights legal proceedings against them or any "Probable Cause" civil rights determinations "for fair housing and/or equal opportunity violations in the delivery of its programs and/or services which have not been remedied. Shelter for the Abused Women & Children, Inc] will become informed of pertinent federal and local civil rights laws and regulations that affect the execution of their services and activities. 5. Posting and Notice: The Shelter for the Abused Women & Children, Inc agrees to post, in conspicuous places available to employees, applicants, and program participants, notices setting forth this policy of nondiscrimination. 6. Certification Statements: The IShelter for the Abused Women & Children, Inc certifies that: A. Programs and services are accessible to persons with disabilities. B. Reasonable accommodation will be provided upon request. C. Facilities used for funded activities are accessible or reasonable alternatives are provided. D. No qualified individual with a disability will be excluded from participation or denied benefits. The IShelter for the Abused Women & Children, Inca agrees to maintain records demonstrating compliance with all these requirements and to cooperate with monitoring, audits, and reviews conducted by the County, Grantor, or their designees. The Shelter for the Abused Women & Children, Inc understands that failure to comply with these requirements may result in corrective action, repayment of funds, suspension or termination of the agreement, or other remedies permitted by law. Signature Page to Follow 'S Community & Human Services Division • 3339 Tamiami Trail East, Suite 213 • Naples, FL 34112-5361 • 239-252-CARE (2273) 239- 252-CAFE (2233) • 239-252-5713 (RSVP) 9 www.collier.gov CAO 1 6 D2 I hereby certify that the organization named above will comply with all applicable nondiscrimination laws, and that all activities under this agreement will be conducted in a manner free of discrimination as defined by the laws and regulations cited herein. Authorized Representative Name: Title: Signature: Date: Organization Name: Address: Phone: Email: Return completed certification via upload into Neighborly. Community & Human Services Division • 3339 Tamiami Trail East, Suite 213 • Naples, FL 34112-5361 • 239-252-CARE (2273) 239- 252-CAFE (2233) • 239-252-5713 (RSVP) • www.collier.gov CAO 16D2 ATTACHMENT TO EXHIBIT I, For Information Purposes only Please consider the environment before printing this page `WA EQUAL OPPORTUNITY Definitions of Laws and Regulations Constitutional Basis. The guarantee of civil rights has a constitutional as well as statutory base. Civil rights laws are an extension and interpretation of the equal protection and due process requirements of the United States Constitution. Overlapping Coverage of Activities. More than one civil rights law may apply to a single type of activity. D.C. LANGUAGE ACCESS ACT OF 2004: Provides greater access and participation in public services, programs, and activities to residents of the District of Columbia with limited or no -English proficiency by requiring that District government programs, departments, and services assess the need for, and offer, oral language services; provide written translations of documents into any non-English language spoken by a limited or no -English proficient population that constitutes 3 percent or 500 individuals, whichever is less, of the population served or encountered, or likely to be served or encountered. "Equal Access and Full Participation" allows LEP residents to be informed of, participate in, and benefit from public services, programs and activities offered by a city department or agency at a level equal to English proficient individuals. "Limited or no English Proficiency" means the inability to adequately understand the English language or express oneself in the spoken or written English language. EXECUTIVE ORDER 13166: Eliminates, to the extent possible, limited English proficiency as a barrier to full and meaningful participation by beneficiaries in all federally assisted conducted programs and activities. Section 808(e)(5) of TITLE Vlll OF THE CIVIL RIGHTS ACT OF 1968, as amended (FAIR HOUSING ACT): Requires grantees to administer its housing and community development programs in a manner to Affirmatively Further Fair Housing (AFFH). HOUSING AND COMMUNITY DEVELOPMENT ACT of 1974 §104 (b)(2), as amended and the National Affordable Housing Act §105 (b)(3): Require that localities certify they will AFFH. Policies should actively promote greater housing opportunities for all persons while maintaining a non-discriminatory environment in all aspects of public and private housing markets. Activities can range from education, outreach, enforcement, avoiding undue concentration of assisted persons in areas with low- and moderate- income persons, provide translation and interpretation services for persons who are Limited English Proficient, assist in the development of accessible housing for persons with disabilities, etc. EXECUTIVE ORDER 12892: Leadership and Coordination of Fair Housing in Federal Programs: Affirmatively Furthering Fair Housing, as amended: Requires federal agencies to affirmatively further fair housing in their programs and activities, and provides that the Secretary of HUD will be responsible for coordinating the effort. The Order also establishes the Presidents Fair Housing Council, which will be chaired by the Secretary of HUD. Updated 03/120PM:EU:SPG TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 (TITLE VI): Prohibits discrimination based on race, color or national origin in programs and activities receiving "Federal financial assistance." Complaints received from a program participant or service recipient will be forwarded to the Fair Housing Equal Opportunity division at the U.S. Department of Housing and Urban Development. htti)s://www.iustice.00v/crt/fcs/TitleVI-Overview EXECUTIVE ORDER 11063, NON-DISCRIMINATION: (Non - Discrimination and Equal Opportunity in Housing) directs HUD and all other executive departments and agencies to take appropriate action to promote the abandonment of discriminatory practices regarding property or facilities owned or operated by the Federal Government or provided with Federal financial assistance in the sale, leasing, rental, or other disposition of such property or facilities. AGE DISCRIMINATION ACT OF 1975: Prohibits: (1) discrimination based on age in programs or activities receiving Federal financial assistance directly or through contractual, licensing, or other arrangements; and (2) age distinctions or actions that have the effect, based on age, of: • excluding individuals from, denying them the benefits of, subjecting them to discrimination under, a program or activity receiving federal financial assistance; or • denying or limiting individuals their opportunity to participate in any program or activity receiving Federal financial assistance. SECTION 109, HOUSING & COMMUNITY DEVELOPMENT ACT OF 1974: Requires that no person in the United States shall —on the grounds of race, color, national origin, religion, or sex— be excluded from participation in, be denied benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance made available under the Act. Section 109 also directs that the prohibitions against discrimination based on age under the Age Discrimination Act and the prohibitions based on disability under Section 504 shall apply to programs or activities receiving Federal financial assistance under Title I programs. EXECUTIVE ORDER 11246, as amended: Bars discrimination in federal employment because of race, color, religion, sex, or national origin. This order was superseded by Executive Order 11478 (Sec 401: 1101), which called for affirmative action programs for equal opportunity at the agency level under general supervision of the Civil Service Commission. Title 11 of the AMERICANS WITH DISABILITES ACT of 1990: Title II of the Americans With Disabilities Act prohibits discrimination based on disability in programs, services, and activities provided or made available by public entities. These provisions are the same as those in Section 504, except they apply to all programs and activities— not just those funded with Federal financial assistance. HUD enforces Title 11 when it relates to state and local public housing, housing assistance and housing referrals. EXECUTIVE ORDER 13217: Community -Based Alternatives for Individuals with Disabilities, 6/19/2001: Requires federal agencies to evaluate their policies and programs to determine if any can be revised or modified to improve the availability of community -based living arrangements for persons with disabilities. TITLE IX OF THE EDUCATION AMENDMENTS OF 1972 - Title IX is a comprehensive federal law that prohibits discrimination based on sex in any federally funded education program oractivty. The principle objective of Title IX is to avoid the use of federal money to support sexually discriminatory practices in education programs such as sexual harassment and employment discrimination, and to provide individual +CAO 1 6 D 2 11 Ir- ATTACHMENT TO EXHIBIT �L citizens effective protection against those practices. Title IX applies, with a few specific exceptions, to all aspects of federally funded education programs or activities. In addition to traditional educational institutions such as colleges, universities, and elementary and secondary schools, Title IX also applies to any education or training program operated by a recipient of federal financial assistance. Many of these education program providers/recipients became subject to Title IX regulations when the Title IX final common rule was published on August 30, 2000. APPLICABLE REGULATIONS 24 CFR Part 1: Nondiscrimination in Federally Assisted Programs of HUD: Implementing regulations for Title VI of the Civil Rights Act of 1964. 24 CFR Part 3: Nondiscrimination on the Basis of Sex in Education Programs or Activities receiving Federal Financial Assistance: Implementing regulations for Title IX of the Education Amendments Act of 1972. 24 CFR Part 8: Nondiscrimination Based on Handicap: Implementing regulations for Section 504 of the Rehabilitation Act of 1973. These regulations obligate recipients of funding to make their programs accessible to persons with disabilities. The regulations also establish physical accessibility requirements when Federal financial assistance is used for new construction or rehabilitation of housing. 24 CFR Parts 91.225 (a)(1): Affirmatively Furthering Fair Housing (CDBG Entitlement grantees): Each jurisdiction must certify that it will affirmatively further fair housing, including conducting an analysis of impediments to fair housing choice, taking appropriate actions, and maintaining records. 24 CFR 570.487(b): Affirmatively Furthering Fair Housing (CDBG states and small cities grantees):. Requires the state and each local government to certify that it will affirmatively further fair housing. The state is required to assume responsibility by: (1) conducting an analysis to identify impediments to housing choice; (2) taking appropriate actions to overcome the effects of the impediments; (3) maintaining records of analysis and actions; and (4) ensuring that units of local government funded by the state comply with the certification requirements. 24 CFR 570.601: Fair Housing (CDBG Entitlement grantees): The following apply: Title VI of the Civil Rights Act of 1964 (and implementing regulations at 24 CFR Part 1); Housing and Community Development Act (including §104(b)(2)); and Executive Order 11063, as amended by 12259 (with implementing regulations in 24 CFR part 107. 24 CFR Parts 100-125: Fair Housing. §100: Discriminatory conduct under the Fair Housing Act §103: Fair Housing Complaint processing §107: Nondiscrimination and equal opportunity in housing under EO 11063 §108: Compliance procedures for affirmative fair housing marketing §110: Fair housing poster §115: Certification and funding of State and local fair housing enforcement agencies §121: Collection of data §125: Fair housing initiatives program. 24 CFR 570.206(c): Fair Housing Activities:. CDBG Program Administrative Costs include the provision of fair housing services designed to further the objectives of the Fair Housing Act, including enforcement and other activities designed to further the objective of avoiding concentrations of assisted persons in areas containing a high proportion of low and moderate income persons. 24 CFR Part 91.325(b)(5): Compliance with anti -discrimination laws. A certification that the grant will be conducted and administered in Updated 03AZOPKE0213 conformity with Title VI of the Civil Rights Act of 1964 and the Fair Housing Act, and implementing regulations. 24 CFR 570.608 and Part 35: Lead -Based Paint: Children under age six are particularly susceptible to hazards from lead based paint. Owners of units where lead paint has been controlled can affirmatively market those units to families with children. If a unit has not undergone lead hazard control treatments, a family with children may choose to live in the unit, if the housing provider advises the family of the condition of the unit. A family cannot be forced to permanently move from a unit if the family declines treatment of lead hazards, although the housing provider can offer incentives for the move. CPD-05.09 (issued November 3, 2005). Accessibility Notice: Section 504 of the Rehabilitation Act of 1973 and The Fair Housing Act and their applicability to housing programs funded by the HOME Investment Partnerships Program and the Community Development Block Grant Program. CPD-05-10 (issued November 3, 2005). Accessibility for Persons with Disabilities to Non -Housing Programs funded by Community Development Block Grant Funds - Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act and the Architectural Barriers Act Major Community Development Based Grant (CDBG) activities and the corresponding civil rights laws that affect them. CDBG APPLICABLE FEDERAL CIVIL RIGHTS LAWS ACTIVITY Title VI, Civil Rights Act of 1964 Benefits, Section 109, Housing and Community Development Act of Services 1974, as amended (HCDA 1974) Methods of Section 504, Rehabilitation Act of 1973, as amended Administration Age Discrimination Act of 1975, as amended Section 104, HCDA of 1974, as amended Housing and Title VIII, Civil Rights Act of 1968, as amended (Federal Related Fair Housing Law) Facilities Executive Order 11063, as amended Section 104, HCDA of 1974, as amended Section 109, HCD Act of 1974, as amended Section 3, Housing and Urban Development Act of 1968, Employment as amended (HUDA of 1968) Executive Order 11246, as amended Section 504, Rehabilitation Act of 1973, as amended Contracting Section 109, HCDA of 1974, as amended (Business Opportunities) Section 3, HUDA of 1968, as amended Title VI, Civil Rights Act of 1964 Displacement/ Section 109, HCDA of 1974, as amended Relocation Title VIII, Civil Rights Act of 1968, as amended Section 104, HCDA of 1974, as amended CAC 16D? Exhibit M Collier County Department of Community and Human Services (CHS) Subrecipient/Developer/Vendor Conflict of Interest Disclosure Form The purpose of this document is to assist in the determination of whether additional restrictions, oversight, or other conditions might be advisable prior to execution of any contract or providing assistance. The term "Conflict of Interest" refers to situations in which financial or other personal considerations may compromise, or have the appearance of compromising, professional judgment in following the rules and regulations applicable to your award. Please Note: A family member is defined as: a spouse, child, stepchild, parent, sibling, domestic partner or relative by marriage. Please answer every question in this form and complete the form attachment, if applicable. This form must be provided to your assigned CHS Grant Coordinator. Employee Name: Subrecipient/Sponsor Name: Subrecipient/Sponsor Address: Subrecipient/Sponsor City, State, Zip Code: Agreement Number Funding Source: Agreement Amount: A. Family Relationships: The Shelter for Abused Women & Children, Inc. P.O. Box 10102 Naples, FL 34101 ES25-01 ESG Does any employee, board member or person in your agency have a family member directly or indirectly involved or employed with CHS or Collier County that creates a conflict of interest, or the appearance of a conflict under HUD's Conflict of Interest regulations? ❑ Yes ❑ No (If YES, please complete the attachment) B. Program Relationships: Does any employee, board member or person in your agency serve or is appointed to an CHS and/or Collier County Board/Committee that may create a conflict of interest, or the appearance of a conflict under the Conflict of Interest regulations? ❑ Yes ❑ No (If YES, please complete the attachment) Does an employee of CHS and/or Collier County serve on your agency's Board of Directors, staff, or in any capacity which may create a conflict of interest, or the appearance of a conflict under the Conflict of Interest regulations? Yes ❑ No (If YES, please complete the attachment) CA 16D2 Does any elected official of Collier County serve on the agency's Board of Directors, which may create a conflict of interest, or the appearance of a conflict under the Conflict of Interest regulations? ❑ Yes ❑ No (If YES, please complete the attachment) Is any employee, board member and/or person (as described above) in your agency involved in any other activity, directly or indirectly, with CHS and/or Collier County of that may create a conflict of interest or the appearance of a conflict under the Conflict of Interest regulations? ❑ Yes ❑ No (If YES, please complete the attachment) C. Business Relationships: Is any employee, board member, person in your agency, or a family member involved as an investor, owner, employee, consultant, contractor, or board member with an entity that has a contractual relationship with CHS and/or Collier County to provide goods or services, sponsor development activities, and/or receive referrals from CHS and/or Collier County? ❑ Yes ❑ No (If YES, please complete the attachment) I understand that, under this agreement, no employee, board member, person in my agency, or family member involved in working on the grant program, in any capacity, may be involved as an investor, owner, employee, consultant, contractor, or board member with an entity that has a contractual relationship with my organization to provide goods or services, sponsor development activities, and/or receive referrals. ❑ Yes ❑ No I have read and understand the Conflict of Interest Disclosure Form. I have disclosed all information required by this disclosure, if any, in an attached statement. I agree to comply with any conditions or restrictions imposed by the CHS and/or Collier County to reduce or eliminate actual and/or potential conflicts of interest. I will update this disclosure form promptly, if relevant circumstances change. I understand that this Disclosure is not a confidential document. If U.S. HUD determines that a conflict of interest exists, this contract may be voided, and terminated and you may be required to return any and all funding allocated, whether used or not used. Printed Name Date Signature JC O 6 D 2 .. Collier County-CHS Conflict of Interest Disclosure Form Attachment Employee Name: Subrecipient/Sponsor Name Subrecipient/Sponsor Address: Subrecipient/Sponsor City, State, Zip Code: Agreement Number Funding Source: Agreement Amount: IThe Shelter for Abused Women & Children, Inc. P.O. Box 10102 Naples, FL 34101 ES25-01 ESG If you answered YES to any question on the previous page, please complete the relevant section(s) below and provide this completed form to your Grant Coordinator. If you answered NO to ALL the questions, you may discard this attachment. A. Family Relationships: 1. Name of the family member(s) directly or indirectly involved or employed by CHS/Collier County: 2. Do any of the family members work in the program area? ❑ YES . ❑ NO 3. Are any of the family members elected officials of Collier County? Q YES �❑ NO 4. Relationship: 5. Position: B. Program Relationships: 1. Other Activities: Name and describe and federal/county activity and/or program that you/your organization are directly or indirectly involved with? 2. Have you used the agencies' name, resources (facilities, personnel, or equipment), or confidential Q YES 101 NO information in connection with the activity and/or program described in #1 above? If YES, describe the resource used 3. Name of the employee, board member or person (as described above) serving or appointed to serve on an CHS and/or Collier County Committee/Board/program: 4. Name of board/committee: C'AO 16D2 5. Does any CHS employee or County official serve I❑ I YES ❑ j NO on your agency's Board of Directors? If yes, please complete the following information: Name: i Position: Department: Supervisor: C. Business Relationships: Please complete this section for EACH business relationship or attach a separate explanation of business and research activities. 1. Name of Business: 2. Categorize the business' relationship with CHS and/or Collier County: Briefly describe the business, or licensing activity: 3. Who is involved with the business? — Check all that apply Describe the position or involvement — Check all that apply 4. Are they receiving any type of compensation? If YES, describe: 5. Who at the CHS and/or Collier County oversees the relationship with this business? Name: Title: Department: Phone: Printed Name Signature ❑ Consultant or Advisor ❑ Research Activities ❑ Business or Referrals ❑ Other contractual or business relationship ❑ Employee Name: ❑ Family member (name & relationship): ❑ Owner/Investor ❑ Board Member ❑ Employee/Manager ❑ Other: 1❑jYES ❑INO Date CAO 6 D2 EXHIBIT IN AFFIDAVIT REGARDING LABOR AND SERVICES Effective July 1, 2024, pursuant to § 787.06(13), Florida Statutes, when a contract is executed, renewed, or extended between a nongovernmental entity and a governmental entity, the nongovernmental entity must provide the governmental entity with an affidavit signed by an officer or a representative of the nongovernmental entity under penalty of perjury attesting that the nongovernmental entity does not use coercion for labor or services. Nongovernmental Entity's Name: The Shelter for Abused Women & Children, Inc. Address: P.O. Box 10102 Phone Number: Authorized Representative's Name: Authorized Representative's Title: Email Address: Project Name: Shelter Operations Project Number ES25-01 AFFIDAVIT I, (Name of Authorized Representative), as authorized representative attest that (Name of Nongovernmental Entity) does not use coercion for labor or services as defined in § 787.06, Florida Statutes. Under penalty of perjury, I declare that I have read the foregoing Affidavit and that the facts stated in it are true. (Signature of authorized representative) Date STATE OF COUNTY OF Sworn to (or affirmed) and subscribed before me, by means of ❑ physical presence or ❑ online notarization this day of , 201 by (Name of Affiant), who produced their as identification or are personally known to me. Notary Public (not required when digital) Commission Expires Personally Known ❑ OR Produced Identification ❑ Type of Identification Produced: C AO I 6D2. EXHIBIT b 1 COLLIER COUNTY COMMUNITY & HUMAN SERVICES NEVER CONTRACT WITH THE ENEMY CERTIFICATION Subrecipient Name: The Shelter for Abused Women & Children, Inc. JSubrecipient Address: k.O. Box 10102, Naples, FL 34101 Project Name: Shelter Operations Project No: S25-01 In accordance with 2 CFR Part 183 and 2 CFR 200.15,',The Shelter for Abused Women & Children, Inc shall exercise due diligence to ensure that no funds, including supplies and services, received under this Agreement are provided directly or indirectly (including through subawards or contracts) to a person or entity who is actively opposing the United States or coalition forces involved in a contingency operation in which members of the Armed Forces are actively engaged in hostilities, which must be completed through 2 CFR 180.300 prior to issuing a subaward or contract. I he Shelter for Abused Women & Children, Inca shall terminate or void, in whole or in part, any subaward or contract with a person or entity listed in the System for Award Management (SAM.gov) as a prohibited or restricted source pursuant to subtitle E of the Title VIII of the NDAA for FY 2015, unless the Federal agency provides written approval to continue the subaward or contract. The COUNTY and/or Federal agency has the authority to terminate or void this Agreement, in whole or in part, in the COUNTY or Federal agency becomes aware that r he Shelter for Abused Women & Children, Inca has failed to exercise due diligence as required above or if the COUNTY or Federal agency becomes aware of any funds received under this Agreement have been provided directly or indirectly to a person or entity who is actively opposing coalition forces involved in a contingency operation in which members of the Armed Forces are actively engaged in hostilities. By signing this form, I certify that The Shelter for Abused Women & Children, Inca will not contract or subcontract with any person or entity that is actively opposing the United States or which the Armed Forces are actively engaged in hostilities. Name: Signature: Title: Date: I CAO It-.1- Collier Count Community & Human Services Lision EXHIBIT P N/A CONSENT TO VERIFY IMMIGRATION STATUS 1 6 D 2 SUBRECIPIEN Name: The Shelter for the Abused Women & Children, Inc. Program or Project Title Shelter Operations Grant/Contract Number: ES25-01 Notice to applicants and tenants: In order to be eligible to receive 1HU0 assistance, each applicant for, or recipient of, Wo assistance, must be lawfully within the United States. Please read the Declaration Statement carefully and sign. Please feel free to consult with an immigration lawyer or other immigration expert of your choosing. Providing personal information is voluntary and the information will be verified using the SAVE system, however, if the information is not provided, you will not be eligible to receive 1HUDI, assistance. I, :certify, swear, and affirm, under penalty of perjury, under the laws of the United States of America, that to the best of my knowledge, I am lawfully within the United States because: (Please check appropriate item below.) �E] I am a citizen by birth, a naturalized citizen, or a national of the United States ❑ I have eligible immigration status as checked below (see reverse side of this form for explanations). Attach INS document(s) evidencing eligible immigration status and signed verification consent form. �Ell Immigration status under §§101(a)(15) or 101(a)(20) of the Immigration and Nationality Act (INA) ❑ Permanent residence under §249 of the INA ❑ Refugee, asylum, or conditional entry status under §§ 207, 208, or 203 of the INA ❑ Parole status under §212(d) of the INA ❑ Threat to life or freedom under §§234(h) of the INA ❑ Amnesty under §A of the INA By my signature below, I consent to U.S. Citizenship and Immigration Services releasing my records to Collier County Community and Human Services Division and the Shelter for Abused Women & Children, Inca. I certify, swear, and affirm that the information in this request is complete, true, and correct. Signature: Date: Address: Phone: Email: ❑ Check box if signature is of an adult residing in the unit who is responsible for a child named on the statement above. �IA: Enter INA/SAVE Primary Verification E: Date: S Community & Human Services Division • 3339 Tamiami Trail East, Suite 213 • Naples, FL 34112-5361 • 239-252-CARE (2273) 110 141 r A r6 /77'2'21 . 110 141 4'71 Z IDQATD\ . ,.,.,..,. ,., 1V., ..,.., CAO 1 6 D 2 Warning: 18 U.S.C. 1001 provides, among other things, that whoever knowingly and willfully makes or uses a document or writing containing any false, or fraudulent statements or entry, in any matter within the jurisdiction of any department or agency of the United States, shall be fined not more than $10,000, imprisoned for not more than five years, or both. The following explanations pertain to noncitizens who declare eligible immigration status in one of the following categories: Immigration status under § 101(a)(15) and 101(a)(20) of the INA. A noncitizen lawfully admitted for permanent residence, as defined by 101(a)(20) of the immigration and nationality act (INA), as an immigrant, as defined by §101(a)(15) of the INA (8.U.S.C. I101(a)(20) and 101(a)(15)), respectively [immigrant status]. This category includes a noncitizen admitted under §210 of 21 OA of the INA (8 U.S.C. 1160 or 1161), [special agricultural worker status], who has been granted lawful temporary resident status. Permanent resident under §249 of the INA. A noncitizen who entered the U.S. before January 1, 1972, or such later date as enacted by law, and has continuously maintained residency in the U.S. since then, and who is not eligible for citizenship, but who is deemed to be lawfully admitted for permanent residence as a result of an exercise of discretion by the Attorney General under §249 of the INA (8 U.S.C. 1259) [amnesty granted under INA 249]. Refugee, asylum, or conditional entry status under §§207, 208, or 203 of the INA. A noncitizen who is lawfully present in the U.S. pursuant to an admission under §207 of the INA (8 U.S.C. 1157) [refugee status]; pursuant to the granting of asylum (which has not been terminated) under §208 of the INA (8 U.S.C. 1158) [asylum status]; or as a result of being granted conditional entry under §203(a)(7) of the INA (8 U.S.C. I I53(a)(7)) before April 1, 1980 because of persecution or fear of persecution on account of race, religion, or political opinion or because of being uprooted by catastrophic natural calamity [conditional entry status]. Parole status under §212(d)(5) of the INA. A noncitizen who is lawfully present in the U.S. as a result of an exercise of discretion by the Attorney General for emergent reasons deemed strictly in the public interest under §212(d)(5) of the INA (8 U.S.C. 1182(d)(5)) [parole status]. Threat of life or freedom under §243(h) of he INA. A noncitizen who is lawfully in the U.S, as a result of the Attorney General's withholding deportation under §243(h) of the INA (8 U.S.C. 1253(h)) [threat to life or freedom]. Amnesty under §245A of the INA. A noncitizen who is lawfully admitted for temporary or permanent residence under §245A of the INA (8 U.S.C. 1255a) [amnesty granted under INA 245A]. A Community & Human Services Division • 3339 Tamiami Trail East, Suite 213 • Naples, FL 34112-5361 • 239-252-CARE (2273) C�O '110'1Q7 1-A VfG Ill 11,. )10 141 Q'11.1 /D CA rM....,.—. 11;o n ,