CTR060358__Contract_Amendment_2.pdf
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- Attached to
- Master Agreement AZ|CTR060358
- Contract number
- CTR060358
- Issued by
- Arizona
About this file
This document is a Contract Amendment issued by the Arizona Department of Economic Security (ADES) for Contract Number CTR060358, Amendment Number Two, with Human Services Campus, Inc. The amendment pertains to Homeless Youth Street Outreach and Drop-In Center Services.
The contract amendment establishes a reimbursement ceiling of $148,436.00 for the contract period of July 1, 2023 through June 30, 2024. The budget includes personnel expenses for street outreach staff totaling $125,760.00, essential client services of $36,390.00 (with $10,100.00 covered by ADES), and indirect costs of $12,576.00 using a 10% de minimis rate. The total contract cost is $174,726.00, with ADES providing $148,436.00 in funding. The services primarily focus on street outreach programs, including staff positions like Street Outreach and Street Outreach Navigator, along with supporting expenses such as employee training, food, hygiene kits, laptops, and other essential client services.
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CONTRACT AMENDMENT
Arizona Department of Economic Security
1789 W Jefferson Street, Mail Drop 1541, Phoenix, AZ 85007
CONTRACT NUMBER: AMENDMENT NUMBER:
CTR060358 Two (2)
DESCRIPTION/ LABEL: Homeless Youth Street Outreach and Drop-In Center Services
CONTRACTOR NAME: Human Services Campus, Inc.
THE ABOVE REFERENCED CONTRACT IS HEREBY MODIFIED AS FOLLOWS:
Pursuant to the ADES Special Terms and Conditions, Section 26, Levels of Service, the purpose of this amendment is to add the initial contract reimbursement ceiling for the period of July 1, 2023 through June 30, 2024 in the amount of $148,436.00.
Therefore, the Itemized Service Budget for the period of July 1, 2023 through June 30, 2024 is added and attached.
ALL OTHER REQUIREMENTS, SPECIFICATIONS, AND TERMS AND CONDITIONS REMAIN UNCHANGED
ACKNOWLEDGEMENT AND AUTHORIZATION
This Amendment shall be fully executed by means of electronic approval in APP.
TOTAL FTE Level (i.e., 1.0, 0.5, 0.25)
Service Code (O or D) Position Title TOTAL COST ADES COST
2 O Street Outreach 78,336.00 78,336.00
1 O Street Outreach Navigator 47,424.00 47,424.00
TOTAL # of FTEs: [ 3 ] 125,760.00$ 125,760.00$
Service Code (O or D) Basis TOTAL COST ADES COST
O Employee Training 3,000.00 3,000.00
O Mileage 15,210.00 0.00
O Cell Phones 1,080.00 0.00
O Food, Water, Pet Food, Clothing, Hygiene Kits 15,000.00 5,000.00
O x3 Laptops 2,100.00 2,100.00
36,390.00$ 10,100.00$
Service Code (O or D) Basis TOTAL COST ADES COST
Service Code (O or D) Basis TOTAL COST ADES COST
TOTAL: -$ -$
TOTAL:
3) TOTAL DROP-IN CENTER OPERATIONS EXPENSES
Maintenance, rent, security, fuel, equipment, insurance, utilities, phones, internet, shower, laundry, storage lockers, pet cages, furnishings, food, cell phone charging stations, staff training, supplies necessary for operation of a Drop-in Center.
TOTAL:
4) HMIS EXPENSES
Purchasing or leasing computer system equipment, obtaining technical support; paying a portion of utilities, and high-speed data transmission necessary to operate or contribute data to the HMIS; paying salaries for operating HMIS, i.e. data entry, monitoring and reviewing data quality, and data analysis
5) INDIRECT COSTS
TOTAL:
2) TOTAL ESSENTIAL CLIENT SERVICES FOR STREET OUTREACH AND/OR DROP-IN CENTER
Case Management, child care, education services, employment assistance (i.e., fingerprint clearnance card, uniforms, ID), life skills training, transportation, mileage, vehicle lease (vehicles cannot be purchased with these funds), emergency health services, emergency mental health services, hygiene items, food, water, pet food, clothing, cell phone service/usage charges, and services for special populations (e.g., services for people living with HIV/AIDS and victim services). These are non-employee expenses.
CONTRACT NUMBER: CTR060358CONTRACT PERIOD: 07/01/2023 to 06/30/2024
SERVICE CODES: O = Street Outreach D = Drop-in Center
1) TOTAL PERSONNEL & EMPLOYEE RELATED EXPENSES FOR DIRECT SERVICES (One Service Code Per Line) Compensation directly related to carrying out the activities of the identified Service Code as well as other costs such as insurance, workers compensation, etc.
EXHIBIT A
Homeless Youth Outreach and Drop-in Center Services
ITEMIZED SERVICE BUDGET
CONTRACT SERVICE PROVIDED: HML Youth Street Outreach and Drop-In Services ORGANIZATION: Human Services Campus, Inc.
Indirect Cost Rate (i.e. 10% de minimus rate or
Federally negotiated rate)
Service Code (O or D) Basis TOTAL COST ADES COST
10% de minimis rate O 10% de minimis rate 12,576.00 12,576.00
12,576.00$ 12,576.00$
174,726.00$ 148,436.00$
TOTAL COST ADES COST
6) 174,726.00$ 148,436.00$
7)
8) Calculate total HMIS COST
9) TOTAL COSTS BY SERVICE CODES: 174,726.00$ 148,436.00$
* If red, ensure the total matches the Total Cost above
* If red, ensure the total matches the ADES Cost above
10) REVENUE SOURCES: TOTAL COST ADES COST
ADES-HOMELESS 174,726.00$ 148,436.00$
Government Funding - City
Government Funding - County
Gov. Funding - Federal
Foundation & Corporate Support
United Way
Contributions / Donations
Special Events / Fundraising
Legacies / Bequests / Investments
Program Service Fees & Reimbursements
In-Kind Support
Other Revenue*
* Identify Other Revenue Sources Here TOTAL REVENUE: 174,726.00$ 148,436.00$ Bingo Proceeds
Government Funding – State (Do not include ADES Homeless Program funding listed above)
Costs incurred for the benefit of multiple programs, functions, or other cost objectives, and therefore, cannot be identified readily and specifically with a particular program or other cost objective. Indirect costs typically support administrative overhead functions such as fringe benefits, accounting, payroll, purchasing, facilities management, utilities, etc. If the subrecipient elects to use a federally negotiated indirect cost rate, they must provide a copy of the rate agreement with the ISB. If the federally approved indirect cost rate changes or is allowed to expire within the contract period, the subrecipient must notify DES of the changes. If the subrecipient elects to use the 10% de Minimus rate for indirect costs, they must complete and submit the Exhibit B Certification of De Minimus Indirect Cost Rate form.
TOTAL:
Total Costs by Above Budget Categories
Manually Calculate Total Street Outreach (O) COST
Manually Calculate Calculate Total Drop-in Center (D) COST
| DCAD_HSCCTR060358ISBv5Rev.pdf |
| ISB |
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