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13-25
Resolution No. 13-25 RESOLUTION AUTHORIZING EXECUTION OF A COMMUNITY DEVELOPMENT BLOCK GRANT SUB-RECIPIENT AGREEMENT WITH THE OPEN DOOR CLINIC OF GREATER ELGIN FOR THE REPLACEMENT OF LOCKS AND THE INSTALLATION OF WIRELESS CONTROLLED ALARM SYSTEMS BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN, ILLINOIS,that Sean R. Stegall,City Manager,and Kimberly A.Dewis,City Clerk,be and are hereby authorized and directed to execute a community development block grant agreement on behalf of the City of Elgin with the Open Door Clinic of Greater Elgin for the replacement of locks and the installation of wireless controlled alarm systems, a.copy of which is attached hereto and made a part hereof by reference. s/David J. Kaptain David J. Kaptain, Mayor Presented: February 27, 2013 Adopted: February 27, 2013 Omnibus Vote: Yeas: 6 Nays: 0 Attest: s/Kimberly Dewis Kimberly Dewis, City Clerk r 1 AGREEMENT BETWEEN THE CITY OF ELGIN AND OPEN DOOR CLINIC OF GREATER ELGIN This AGREEMENT is entered into as of the 27th day of February , 2013,by and between the CITY OF ELGIN, an Illinois municipal corporation (hereinafter called "GRANTEE" or "CITY") and the OPEN DOOR CLINIC OF GREATER ELGIN, a not-for-profit corporation incorporated pursuant to the laws of the State of Illinois (hereinafter called "SUB-RECIPIENT"), having a principal place of business at 164 Division Street, 6`h Floor, Elgin, Illinois 60120. 1. RECITALS A. CITY has applied for Community Development Block Grant funds (hereinafter referred to as "CDBG funds") from the United States Department of Housing and Urban Development (hereinafter called "HUD") as provided by the Housing and Community Development Act of 1974, as amended(P.L. 93-383) (hereinafter called"ACT"). B. CITY has amended Program Year 2012-2013 Annual Action Plan to make funds available to additional sub-recipients. C. CITY has considered and approved the application of SUB-RECIPIENT for CDBG funds allotted to CITY for distribution to SUB-RECIPIENT. D. The CITY and SUB-RECIPIENT enter into this Agreement pursuant to their respective powers to enter into such agreements, as those powers are defined in the Illinois Constitution and applicable statutes. H. SCOPE OF THE PROJECT A. SUB-RECIPIENT hereby agrees to perform, in a timely fashion, the activities provided for herein, and those previously defined in the application and project description dated December 12, 2012, submitted by the SUB-RECIPIENT entitled "Security and Confidentiality Improvements", a copy of which is attached hereto as Exhibit "A" and incorporated herein by this reference (hereinafter referred to as the "PROJECT"). The SUB-RECIPIENT was awarded a grant for Fiscal Year(FY) 2012-2013. B. All funding provided to SUB-RECIPIENT shall be used solely replace and upgrade the existing locks and install new wireless controlled alarm systems at the agency's main building, located at 164 Division Street, 6`h Floor, Elgin, Illinois. About 250 low and moderate-income clients of the agency will benefit from the SUB-RECIPIENTS's program in its 2012-2013 fiscal year. The subject building will serve 70 percent low and moderate income persons as defined by 24 CFR 570.208 (a)(2)(i)(A). Such funding shall be used only to replace and upgrade the existing locks and install new wireless controlled alarm systems, and other costs associated with the above activity as are consistent with the scope and intent of the PROJECT and are pre-approved by CITY staff. Page 1 of 19 C. The SUB-RECIPIENT shall comply with administrative and procurement requirements as applied to the Community Development Block Grant program in accordance with 24 CFR 85: 1. The Bid Specifications shall include all specifications and pertinent attachments and shall define the items or services in order for the bidder to properly respond. 2. The SUB-RECIPIENT shall submit the Bid Specifications and plans to the City's Community Development Department for staffs approval prior to advertising in a local newspaper and the Dodge Construction News. 3. The SUB-RECIPIENT shall include in the invitation for bids, the statement "Minorities and women contractors are encouraged to submit bids." The SUB- RECIPIENT shall purchase a 1" x 3" space in the Dodge Construction News Classified Section specifically inviting Minority Business Entity/Women Business Entity(MBE/WBE) firms to submit bids. 4. All bids will be publicly opened at the time and place prescribed in the invitation for bids. 5. The SUB-RECIPIENT shall provide the City's Community Development Department with a copy of the classified advertisement and the results from the bid opening. 6. The contract award will be awarded, in writing, to the lowest responsive and responsible bidder. Any or all bids may be rejected, if there are sound documented reasons. D. The SUB-RECIPIENT shall comply with the Federal Labor Standards and Prevailing Wage Rates as applied to the Community Development Block Grant Program in accordance with Title 29 of the Code of Federal Regulations, Part 5: 1. After the start of the described work, the SUB-RECIPIENT shall provide to the City's Community Development Department staff, weekly reports of the contractor and/or subcontractors at the job site. The SUB-RECIPIENT shall conduct employee interviews of the contractor and/or subcontractors at the job site. 2. Originals of all documents required for compliance with the Federal Labor Standards shall be supplied to the City's Community Development Department. 3. SUB-RECIPIENT shall erect a sign in a prominent place at the job site crediting the City of Elgin and HUD for funding of the PROJECT by including the following statement: "Funding for the Project has been provided, in part, by the City of Elgin from the U.S. Department of Housing and Urban Development's Community Development Block Grant Program.' Page 2 of 19 E. Quarterly Progress Reports 1. The SUB-RECIPIENT shall provide a Quarterly Progress Report to the CITY each quarter, reporting on the status of the PROJECT in relation to the Project Implementation Schedule. The quarterly progress reports shall begin upon the signing of this Agreement, and be based on the CDBG program year, beginning on June I" and ending on May 31" of the following year. The quarterly progress report shall be submitted until the completion of the project or until directed to discontinue such reports in writing by the CITY. 2. Quarterly progress reports shall be due on the 10`h day of the month following, the end of the quarter, for the previous quarter's activities. 3. The SUB-RECIPIENT shall use a form provided by the Community Development Department and shall include all required information about the number of clients served each quarter (by race, income, and the number of female headed households). F. Request for Payment 1. The SUB-RECIPIENT shall provide the City's Community Development Department, prior to the start of construction, with an itemized list of all estimated expenditures. This list (on a State of Illinois Engineer's Pay Estimate form BLR-283 or equivalent) shall show expected quantities and unit prices for each item. 2. Request for payment shall be submitted on a timely basis. Each request for payment sent to the CITY shall be accompanied by said payment estimate form signed by the SUB-RECIPIENT'S authorized representative and showing the work completed. Changes to items on the pay estimate form must be authorized, in writing, by the SUB-RECIPEINT (on a State of Illinois Request for Approval of Change in Plans Form BLR-228 or equivalent), and a copy of such authorization shall be submitted to the City's Community Development Department before payment pursuant to such changes is made. G. Prior to the expenditure of CDBG funds, the SUB-RECIPIENT shall meet with the City's Community Development Department staff to establish acceptable documentation and guidelines regarding requests for payment for the activities described in the Scope of Work. No payment of CDBG funds will be made by the CITY without the required documentation. H. SUB-RECIPIENT shall record and report monthly to the CITY all program income (as defined in 24 CFR 570.500(a)) generated by activities carried out with CDBG funds made available under this Agreement. Any such program income shall be returned to the CITY. Written request for an exception to this section must be made in writing to the CITY's Community Development Department. Such request shall describe why the SUB-RECIP ENT needs the income, the specific activities the SUB-RECIPIENT will undertake with the funds, and how the SUB-RECIPIENT will report income and expenditures to the CITY. A written response to the request will be provided to the SUB- RECIPIENT from the CITY. The use of any program income by the SUB-RECIPIENT shall comply with the requirements set forth at 24 CFR 570.504. By way of further Page 3 of 19 1 limitations, to the extent any such income is used during the Agreement period for activities permitted under this Agreement, SUB-RECIPIENT shall reduce requests for additional funds by the amount of any such program income balances on hand. All unexpended program income shall be returned to the CITY at the end of this Agreement period. Any interest earned on cash advances from the U.S. Treasury and from funds held in a revolving fund account is not program income and shall be remitted promptly to the CITY. III. AMOUNT AND TERMS OF GRANT A. The CITY shall distribute to SUB-RECIPIENT, as SUB-RECIPIENT'S portion of the total grant received by the CITY and in consideration of SUB-RECIPIENT'S undertaking to perform the PROJECT, a maximum of$26,897 (hereinafter "Grant Funds"), to be paid in the manner set forth herein at Section VII. B. This PROJECT shall be identified by the following project and account numbers: Project No. 154856 and Account No. 230-0000-791.93-36 in the amount of $26,897, which identifying numbers shall be used by SUB-RECIPIENT on all payment requests. C. In the event the services identified in Section II, Scope of the Project of this Agreement or other eligible services for low and moderate income individuals and households are no longer provided at the SUB-RECIPIENT's main building, located at 164 Division Street, 6`h Floor, Elgin, Illinois, due to actions by the SUB-RECIPIENT, the SUB-RECIPIENT shall reimburse the U.S. Department of Housing and Urban Development or the CITY for project activities undertaken in whole or in part with CDBG funds at a rate of 6.7% for each year and portion of each year remaining on the ten-year useful life of the facility improvements. The ten-year compliance period shall begin on the commencement date of this Agreement. This provision shall not be construed as limiting the CITY from asserting any claims against the SUB-RECIPIENT, for the breach of any other terms of this Agreement. D. Upon project completion as specified in Section II, Scope of the Project, any remaining CDBG project funds shall be available for reallocation by the CITY to another eligible CDBG project. If SUB-RECIPIENT materially fails to comply with any term of this award, the SUB-RECIPIENT shall repay to the CITY all funds used for ineligible activities. E. A minimum of 51 percent of the persons served on an annual basis shall be at or below 80 percent of the Median Family Income in order for the SUB-RECIPIENT to maintain eligibility for the CDBG funds provided for herein. Said income levels shall be updated and revised annually to conform to levels set by the U. S. Department of Housing and Urban Development. Failure to meet the aforementioned minimum 51 percent threshold shall require SUB-RECIPIENT to reimburse the CITY for funds expended, in whole or in part, for project activities. F. Changes in the scope of services, budget, or method of compensation contained in this Agreement, unless otherwise noted, may only be made through a written amendment to this Agreement, executed by the SUB-RECIPIENT and CITY. Page 4 of 19 N. SUB-RECIPIENT'S COMPLIANCE WITH THE ACT A. CITY shall assist SUB-RECIPIENT'S making application for CDBG funds. B. SUB-RECIPIENT shall abide by the ACT, and all HUD rules and regulations promulgated to implement the ACT. C. SUB-RECIPIENT shall, upon request of CITY, (1) assist in the completion of an environmental review and (2) complete certifications showing equal employment opportunity compliance including equal employment opportunity certification with reference to the PROJECT, as set forth in Exhibit "C" attached hereto and made a part hereof. D. SUB-RECIPIENT, in performing under this Agreement, shall: 1. Not discriminate against any worker, employee, or applicant, or any member of the public, because of race, creed, color, sex, age or national origin, nor otherwise commit an unfair employment practice; and 2. Take affirmative action to insure that applicants are employed without regard to race, creed, color, sex, age or national origin, with such affirmative action in- cluding, but not limited to the following: Employment, upgrading, demotion or transfer, termination, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, selection for training, including apprenticeship. E. SUB-RECIPIENT shall permit CITY and HUD to conduct on-site reviews, examine personnel and employment records and to conduct any other procedures or practices to assure compliance with the provisions of this Agreement. SUB-RECIPIENT agrees to post in conspicuous places available to employees and applicants for employment notices setting forth the provisions of this non-discriminatory clause. F. SUB-RECIPIENT shall comply with all laws and state and federal rules and regulations, including but not limited to those regarding a direct or indirect illegal interest on the part of any employee or elected official of the SUB-RECIPIENT in the PROJECT or payments made pursuant to this Agreement. G. SUB-RECIPIENT hereby warrants and represents that neither the PROJECT, including but not limited to any funds provided pursuant thereto, nor any personnel employed in the administration of the program shall be in any way or to any extent engaged in the conduct of political activities in contravention of Chapter 15 of Title 5, United States Code, referred to as the Hatch Act. H. SUB-RECIPIENT shall maintain records to show actual time devoted and costs incurred, in relation to the PROJECT, and shall prepare and submit quarterly progress reports which describe the work already performed and anticipated during the remaining time of the PROJECT. Upon fifteen(15) days notice from the CITY, originals or certified copies of all time sheets, billings, and other documentation used in the preparation of said progress reports shall be made available for inspection, copying, or auditing by the CITY at any time during normal business hours, at 150 Dexter Court, Elgin, Illinois. Paee 5 of 19 I. SUB-RECIPIENT shall adopt the audit requirements of the Office of Management and Budget (hereinafter "OMB") Circular A-133, "Audits of Institutions of Higher Learning and Other Non-Profit Institutions." SUB-RECIPIENT shall submit to the CITY one copy of said audit report. SUB-RECIPIENT shall permit the authorized representatives of the CITY, HUD and the Comptroller General of the United States to inspect and audit all data and reports of the SUB-RECIPIENT relating to its performance under this Agreement. J. SUB-RECIPIENT and CITY shall at all times observe and comply with Title 24 CFR Part 570 and all applicable laws, ordinances or regulations of the Federal, State, County, and local government, which may in any manner affect the performance of this Agreement. Without limiting the foregoing, the SUB-RECIPIENT shall comply with the regulations, policies, guidelines and requirements set forth in Exhibit B, attached hereto and incorporated herein by this reference. K. SUB-RECIPIENT shall transfer to the CITY any unused CDBG funds and submit all billings attributable to this Project at the time this Agreement expires. L. SUB-RECIPIENT will ensure that any real property under the SUB-RECIPIENT'S control that was acquired and/or improved in whole or in part with CDBG funds is used to meet the benefit of low and moderate income persons as defined by HUD, for a period of 10 years after the commencement of this Agreement. M. If during the 10 year period after the commencement of this Agreement, the SUB- RECIPIENT disposes of any property under the SUB-RECIPIENT'S control that was acquired and/or improved in whole or in part with CDBG funds, then the SUB- RECIPIENT will reimburse the CITY in the amount of the current fair market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for acquisition of, or improvement to, the property in accordance with 24 CFR 570.503(b)(8) and 24 CFR 570.505. V. RIGHTS TO SUBCONTRACT A. SUB-RECIPIENT is herewith granted authority to subcontract all or any portion of the PROJECT to such engineers, architects, independent land use consultants, professional land planner, construction contractors or other entities as SUB-RECIPIENT shall deem appropriate or necessary and upon such terms as may be acceptable to SUB-RECIPIENT. B. Administration of any subcontracts by the SUB-RECIPIENT shall be in conformance with 24 CFR Part 570.200(d)(2) and Part 85.36. VI. SUB-RECIPIENT'S AUTHORIZATION TO ACCEPT PROPOSALS A. After the CITY has received notification that funds for the PROJECT have been released by HUD, the SUB-RECIPIENT shall be authorized to accept the proposal of any subcontractor for the PROJECT. VII. BILLING PROCEDURE Page 6 of 19 i A. Upon release of Grant Funds by HUD for the PROJECT, the CITY shall make disbursements to the SUB-RECIPIENT as either reimbursement for advances made by SUB-RECIPIENT or as advances for specific cash requirements of SUB-RECIPIENT for the PROJECT. All claims of SUB-RECIPIENT, whether for reimbursement or advancement, shall comply with the following requirements: 1. SUB-RECIPIENT shall submit a listing of all disbursements of CDBG funds, on a form provided by the CITY; 2. Any claim for advancement of CDBG funds shall be limited to an amount necessary for SUB-RECIPIENT to meet specific cash requirements for the PROJECT and shall be disbursed by SUB-RECIPIENT within three (3) working days of receipt by SUB-RECIPIENT; 3. Any request for reimbursement or advancement pertaining to work under contracts from the SUB.-RECIPIENT shall include the following: a. For interim payments to contractors and subcontractors, certification that the work for which payment is requested has been performed and is in place and to the best of SUB-RECIPIENT'S knowledge, information and belief that, the quality of such work is in accordance with the contract and subcontracts, subject to: (i) any evaluation of such work as a functioning PROJECT upon substantial-completion; (ii) the results of any subsequent tests permitted by the subcontract; and(iii) any defects or deficiencies not readily apparent upon inspection of the work; and b. For final payment, certification that the work has been performed in a satisfactory manner and in conformance with the contract. 4. Processing of all requests for payment shall be contingent upon the submission of the required documentation by the contractor and subcontractor to the CITY that fully complies with federal labor standards, uniform relocation act or any other applicable federal, state, or local statutes, rules or regulations. 5. SUB-RECIPIENT shall forward to CITY all billings, vouchers, and other documents representing any accounts payable, in such timely and reasonable manner as both parties shall determine; provided, however, that in no event shall such documents be forwarded to CITY later than twenty-one (21) days after SUB-RECIPIENT'S receipt of such documents. 6. SUB-RECIPIENT shall cooperate with the CITY to facilitate the maintenance of financial records by the CITY as required by Title 24 CFR 85. B. Upon submission of an acceptable claim for Grant Funds, CITY shall process such claim and shall approve such claim for payment following approval by the City's Community Development Department, for compliance with this Agreement and applicable HUD requirements. Page 7 of 19 C. Except as provided for in Section IX and X herein, CITY shall pay all required payments against eligible project costs, as described in Section II.B, incurred by SUB-RECIPIENT under this Agreement. VIII. ADMINISTRATION AND REPORTING REQUIREMENTS A. SUB-RECIPIENT shall administer the Grant Funds in conformance with the regulations, policies, guidelines and requirements of OMB Circular numbers A-110, A-122, and A- 133;as they relate to the acceptance and use of federal funds for the PROJECT. B. SUB-RECIPIENT shall submit all required information to show compliance with applicable laws, rules and regulations, as specified in this Agreement and shall submit to CITY a quarterly progress report no later than the 10th day of the month following the activity being reported. SUB-RECIPIENT shall comply with all reporting and other requirements as specified in Exhibit "B" attached hereto and made a part of this Agreement. C. Relocation of Tenants SUB-RECIPIENT shall comply with the requirement under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970. SUB-RECIPIENT shall maintain a separate relocation file for each displaced person/business for at least three years after the project has been completed or the person/business has received final relocation payments, whichever is later. Relocation costs must be paid to any tenant (residential or nonresidential) who occupies any building being acquired and is forced to move without cause. Waiver of rights to relocation costs can only be done by a single family homeowner. D. Management Plan and Operating Budget of the Facility SUB-RECIPIENT shall maintain, and keep current, a management plan and operating budget stating policies governing the operation of the facility and shall keep this plan and budget on file with the CITY. IX. TERMINATION OF AGREEMENT OR SUSPENSION OF PAYMENT A. During the implementation of the PROJECT, CITY may terminate this Agreement or may suspend payment of Grant Funds to SUB-RECIPIENT for SUB-RECIPIENT'S substantial breach of this Agreement, abandonment of the PROJECT or occurrence rendering impossible the performance by SUB-RECIPIENT of this Agreement. B. During the implementation of the PROJECT, the CITY may suspend payments of Grant Funds, due to use of funds in a manner unrelated to or in breach of this Agreement relative to, SUB-RECIPIENT'S performing the PROJECT, failure by SUB-RECIPIENT in submitting supporting information or documentation for a claim, submission by SUB- RECIPIENT of incorrect or incomplete reports, or SUB-RECIPIENT'S suspension of its pursuit of the PROJECT. Page 8 of 19 C. In the event CITY elects to terminate this Agreement or to suspend payments, for any reason stated herein above in paragraph A and B of this Section IX, it shall notify the SUB-RECIPIENT, in writing, of such action, specifying the particular deficiency, at least five (5) working days in advance of any such action and establishing a time and a place for the SUB-RECIPIENT to refute the alleged deficiency at a time prior to CITY'S taking such action. After allowing the SUB-RECIPIENT the opportunity to refute or correct the alleged deficiency, if the alleged deficiency continues to exist, in the opinion of the CITY, the CITY may withhold payment of the Grant Funds until such time as the violation or breach is remedied. No action taken or withheld by the CITY under this paragraph shall relieve the SUB-RECIPIENT of its liability to the CITY for any funds expended in violation of any of the terms of this Agreement. D. SUB-RECIPIENT shall transfer to the CITY any unused CDBG funds and submit all billings attributable to this Project at the time this Agreement terminates or is suspended. X. REMEDIES A. To the fullest extent permitted by law, SUB-RECIPIENT agrees to and shall indemnify, defend and hold harmless the CITY, its officers, employees, boards and commissions from and against any and all claims, suits,judgments, costs, attorneys fees, damages or any and all other relief or liability arising out of or resulting from or through, or alleged to arise out of, any breach of this Agreement; misuse or misapplication of funds derived pursuant to this Agreement by SUB-RECIPIENT; violation of any statutes, rules and regulations, directly or indirectly, by SUB-RECIPIENT and/or any of its agents or representatives; or any negligent acts or omissions of SUB-RECIPIENT or of SUB- RECIPIENT'S officers, employees, agents or subcontractors. In the event of any action against the CITY, its officers, employees, agents, boards or commissions covered by the foregoing duty to indemnify, defend and hold harmless, such action shall be defended by legal counsel of CITY'S choosing. The provisions of this paragraph shall survive any termination and/or expiration of this Agreement. B. In the event of loss of approved Grant Funds for the PROJECT as a result of any violation or breach of this Agreement by the CITY, misuse or misapplication of funds received from HUD unrelated to the PROJECT, or any violation of the statutes, rules and regulations of HUD, directly or indirectly, by CITY and/or any of its agents or representatives, CITY'S liability to SUB-RECIPIENT shall be limited to any funds which have previously been provided to sub-recipient pursuant to this Agreement. SUB- RECIPIENT hereby waives and releases CITY from any and all other liability pursuant to any such breach, misuse, misapplication or violation of statutes, rules or regulations. C. In the event HUD, or any other federal agency, makes any claim which would give rise to invoking the remedy provisions, as set forth in paragraph A or B of this Section X, then the CITY or SUB-RECIPIENT shall immediately notify the other party, in writing, providing the full details of the alleged violation. To the extent that any such matter is not subject to exclusive federal jurisdiction, venue for the resolution of any disputes or the enforcement of any rights arising out of or in connection with this Agreement between the CITY and SUB-RECIPIENT shall be in the Circuit Court of Kane County, Illinois. Page 9 of 19 D. In addition to any remedies available to the CITY, if CITY has lost or been prevented from receiving any federal funds, other than the Grant Funds, as a result of any alleged violation of law or other breach of this Agreement by SUB-RECIPIENT, or if SUB- RECIPIENT otherwise fails to comply with any term of this award or Agreement, the SUB-RECIPIENT shall repay, upon demand by the CITY, such amount of Grant Funds previously disbursed or allegedly due to the SUB-RECIPIENT. XI. TIMELINESS A. Time is of the essence of this Agreement. SUB-RECIPIENT shall meet the schedule deadlines listed below. Any milestone which the SUB-RECIPIENT does not achieve within two months of the date listed will result in the SUB-RECIPIENT submitting a revised implementation schedule for approval by the City's Community Development staff. Failure to achieve these deadlines may result in the loss or reduction of grant funds at CITY's discretion. Actions Date 1. Prepare Bid Specification February 15, 2013 2. Bids Solicited February 15, 2013 3. Select Contractor February 28, 2013 4. Construction Begins March 1, 2013 5. Construction Completed March 30, 2013 B. SUB-RECIPIENT. Shall complete the PROJECT within twelve (12) months from the date of this Agreement. However, in the event of any alterations or additions or of circumstances beyond the control of SUB-RECIPIENT, which in the opinion of the Community Development Director will require additional time for completion of said expenditures, then in that case, the time of completion shall be extended by the Community Development Director by a period of time not to exceed six (6) months. C. If SUB-RECIPIENT is delayed in the completion of the PROJECT by any cause legitimately beyond its control, as determined by the CITY, such that it cannot complete the PROJECT within eighteen (18) months of the date of this Agreement, it shall immediately give written notice to the CITY of the anticipated delay, the reasons therefore and request an extension of time for completion of the PROJECT. CITY's Community Development Director shall consider any such request and shall make a recommendation to CITY's City Council as to whether in his sole discretion he considers such an extension to be reasonable and necessary, under the totality of circumstances to be required for completion of the PROJECT due to the particular circumstances. The CITY's City Council shall act upon the extension request and recommendation of the Community Development Director and notify the SUB-RECIPIENT whether the time extension is granted or denied, and the CITY's intention to exercise the remedies available herein, including but not limited to suspension of further payments. A revised Page 10 of 19 t implementation schedule shall be submitted by SUB-RECIPIENT if an extension is granted by the CITY. XH. MISCELLANEOUS PROVISIONS A. AMENDMENTS - This Agreement constitutes the entire Agreement between the parties hereto. There are no other agreements, either oral or implied, between the parties hereto regarding the subject matter hereof Any proposed change in this Agreement shall be submitted to the other party for prior approval. No modifications, additions, deletions, or the like, to this Agreement shall be effective unless and until such changes are executed, in writing, by the authorized officers of each party. B. SUBJECT TO FINANCIAL ASSISTANCE AGREEMENT - This Agreement is made subject to financial assistance agreements between the CITY and the United States Department of Housing and Urban Development, with the rights and remedies of the parties hereto being in accordance with any such agreements. C. ASSIGNMENT - Except as provided in Sections V and VI hereof, SUB-RECIPIENT shall not assign this Agreement or any part thereof and SUB-RECIPIENT shall not transfer or assign any Grant Funds or claims due or to become due hereunder, without the written approval of the CITY having first been obtained. D. ATTORNEY'S OPINION - If requested, SUB-RECIPIENT shall provide an opinion of its attorney, in a form reasonably satisfactory to the CITY, that all steps necessary to adopt this Agreement, in a manner binding upon SUB-RECIPIENT, have been taken by SUB-RECIPIENT, and that SUB-RECIPIENT is in compliance with applicable local, state and federal statues, rules and regulations for the purpose of complying with this Agreement. E. HEADINGS - The section headings of this Agreement are for convenience and reference only and in no way define, limit, or describe the scope or intent of this Agreement, and should be ignored in construing or interpreting this Agreement. F. The terms of this Agreement shall be severable. In the event any of the terms or provisions of this Agreement are deemed to be void or otherwise unenforceable for any reason, the remainder of this Agreement shall remain in full force and effect. G. This Agreement shall not be construed to create a joint venture, partnership, employment or other agency relationship between the parties hereto. H. Venue for the resolution of any disputes or the enforcement of any rights between the parties hereto arising out of or in connection with the terms and provisions of this Agreement shall be in the Circuit Court of Kane County, Illinois. Paae 11 of 19 IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the dates recited below. CITY OF ELGIN, an Illinois Municipal Corporation BY: Sean R. Stegall City Manager DATE: ATTEST: Kimberly Ddwis City Clerk SUB-RECIPIENT: The Open D c of Greater Elgin IQ 164 Division treet, rh Floor, Elgin, Illinoi 20 BY: David M. Roesler Executive Director DATE: D d v l ATTEST: Nee 12 of 19 EXHIBIT A SUB-RECIPIENT'S CDBG APPLICATION Paoe 13 of 19 THE COMMUNITY DEVELOPMENT BLOCK GRANT(C n� PROPOSAL APPLICATION FOR CDBG FUNDING: U ENTITLEMENT PROGRAM DEC 14 2012 FISCAL YEAR 2013-20.14. Ly AF-r JUNE 1, 2013 THROUGH MAY 31, 2014 Organization Name: Open Door Clinic of Greater Elgin Project Name: Security/Confidentiality Project Address: 164 Division Street,6th floor,Elgin,II 60120 Exec Director Name: David M.Roesler Address: 164 Division Street,6th floor,Elgin,II 60120 Telephone Number: 847-695-1093 Fax Number: 847-695-0501 E-Mail Address: droesler @opendoorclinic.org Website(if applicable): www.opendoorclinic.org Employer(IRS)ID 36-2899274 DUNS Number: 792064313 Contact Name: Lynne Kennedy Title: Director of Resource&Development Contact Telephone#: 847-695-1093 ext.19 Contact Fax Number: 847-695-0501 Contact E-Mail: lynnek @opendoorclinic.org Website(if applicable): www.opendoorclinic.org PROJECT FUNDING REQUEST CDBG Funds Requested $26896.28 Funding Leveraged from other Sources Check the category,which describes the type of funding,requested: OHousing O Public Facility O Infrastructure OEconomic Development O Public Service O Other BRIEF PROJECT DESCRIPTION: Please provide a one-sentence statement about,your project-not your organization. The security and confidentiality of our clinic is crucial due to client files,medications and funds that are housed in our location. City of Elgin CDBG Application FY 2013-2014 Application Page 14 of 32 CAPITAL PROJECTS ONLY Public Improvements/Construction Activity Application Form Project Name/Title: Security/Confidentiality Agency Name: Open Door Clinic of Greater Elgin Agency Address: 164 Division Street,6th floor City: Elgin State: IL Zip Code: 60120 1. Project Description(Additional sheets are on the last page of this document if needed.) a. Provide a detailed description of the facilities to be provided or improved. Identify major components of proposed work and state estimated quantities: Remove existing mortise locks and install Alarm Lock Pin/prox Networx self contained locksets on fifteen doors total. Estimate includes 25 cards and initial programming of all the Networx entry units. Install 1 IM80211 wireless network hub to communicate to all the doors. Open Door Clinic will provide an intranet connected computer for software installation to program and maintain the entry system and to download audit trail and lock information. After the initial setup,the wireless system will control all programming,lock and audit trail functions from any enabled computer that has access to this program. b. Indicate the primary function of the facilities to be provided or improved: Open Door Clinic is a 501 (c)3 non-profit organization that provides medical care to people living with HIVAIDS. The clinic also provides case management,mental health,substance abuse counseling,lab work,a small food pantry along with diagnosis and treatment of other sexually transmitted diseases. c. Readiness to Proceed: (I) Do you have an architect/engineer under contract? 0 Yes No If,yes please provide name. (ii) Do you have preliminary plans/drawings completed(If yes,please scan and attach)? 0 Yes Oe No (iii) Do you have project cost estimates completed(if yes,please scan and attach)? OQ Yes 0 No (using Davis Bacon Wage Rate and Labor Standards) IPlease note that any costs incurred prior to the award and environmental review process cannot be reimbursed to.the applicant. d. Provide evidence of site control. (Please scan and attach) Copy of deed. If property is not owned provide a copy of the lease. Agreement and letter from owner approving proposed work. City of Elgin CDBG Application FY 2013-2014 Application Page 15 of 32 CAPITAL PROJECTS ONLY 2. Project Location: a. Project Address/Location: (Scan and attach photographs) 164 Division Street,6th floor,Elgin,IL 60120 Census Tract(s): 8546 Block Group(s): 2 b. Indicate if the project is located in,or will have any impact on,the following: (Please indicate Yes or No) (i) Do you have an architect/engineer under contract? Q Yes Qs No If yes,explain: (ii) Designated Wetlands Area: 0 Yes No If yes,explain: (iii) Land Use/Zoning Charge: 0 Yes No If yes,explain: (iv) Environmental Hazards: Q Yes Q No If yes,explain: c. Provide a time line for the project and current status of project progression: Construction Bid Period: Start Date: July 1,2013 Completion Date: July 3,2013 Status: Project is on hold until funding can be procured. 3. Project Benefit: (Additional.sheets at the end of the document.). a. Describe the existing problems or conditions to be corrected by the proposed activity. Identify the persons affected by these conditions. Explain how the project benefits low and moderate income people. Currently Open Door Clinic has several different locks on doors which requires many different keys. Not every employee has keys to every door due to lack of control. With a card system Open Door Clinic will be able to identify door access. The clinic holds very sensitive information regarding our clients and their health. The clinic can not afford to have any of this information to be accessed by non- personnel. Open Door Clinic also houses many medications and medical equipment along with funds. Most of Open Door Clinic clients are very low income and fit into the category. Making sure their identity is secure is our first and foremost concern. b. Describe in quantifiable terms the goals to be achieved by your project during the proposed funding period,and how the recipients of your services will be.benefted or changed. The first.goal is to secure the 6th floor against any unauthorized individuals. HIV/AIDS still has an incredible stigma attached to people living with HIV/AIDS. Some of our clients still work but are low income and they fear their employer,friends or even family find out about their status. This project will relieve them of that concern. City of Elgin CDBG Application FY 2013-2014 Application Page 16 of 32 CAPITAL PROJECTS ONLY Project Budget ACTIVITY CDBG FUNDS OTHER NOW OTHER FEDERAL TOTAL FEDERAL FUNDS FUNDS Acquisition Costs Land Existing structures Other acquisition costs Site Work(not in construction contract) Demolition/clearance Other site costs Construction/Project Improvement Costs New construction Rehabilitation Performance bond premium Construction continency Other $26,896.28j $26,896.28 Architectural and Engineering Architect fees Engineering fees Other A&E fees Other Owner Costs Appraisal fees Survey Soil boring/environmental/LBP evaluation Tap fees and impact fees Permitting fees Legalfees Other Miscellaneous Costs IDeveloper fees JProject reserves Relocation costs Project Administration&Management Costs Marketing/management Operating Taxes Insurance Other GRAND TOTALS $26,896.28 1 1 $26,896.28 City of Elgin CDBG Application FY 2013-2014 Application Page 17 of 32 CAPITAL PROJECTS ONLY 1. tAFOII_FR+3C llREt111EW1r:GU1DWNESTOR.PRI PROFILC0NSTRUCT10NPROJECfS: All construction contracts in excess of $2,000 will be subject to federal Davis-Bacon Wage Rates and Labor Standards provisions. A schedule of current prevailing wage rates and fringe benefits is available at the Illinois Department of Labor at www.state.il.us\aqencv\idol\rates\evenmo\kane9999.htm. $25,000-$99,999 Projects over $25,000 require Newspaper Advertisement Public Solicitation of Contractor Bids in Elgin Standard Times. Federal requirements for Davis-Bacon and Minority and Women Business Enterprise Participation(MBE/WBE)compliance will be applicable. Federal Section 3 and City of Elgin Minority Workforce Requirements are not applicable for contracts under$100,000. The lowest qualified bid representing the complete scope of work from a QUALIFIED CONTRACTOR will be considered. $100,000+ Projects over $100,000 require Newspaper Advertisement Public Solicitation of Contractor Bids in Elgin Standard Times. Federal requirements for Davis-Bacon and Minority and Women Business Enterprise Participation MBE/MBE)compliance will be applicable. Federal Section 3 and City of Elgin Minority Workforce Requirements will be applicable for contracts over$100,000. Bond Requirement- 100%Payment and Performance Bonds. The lowest qualified bid representing the complete scope of work from a QUALIFIED CONTRACTOR will be considered. City of Elgin CDBG Application FY 2013-2014 Application Page 18 of 32 2. PROJECTELIGIBILTY:SECTlON A. This project is located in 8,546 Census Tract(s) (Identify tract by number) (website-Factfinder.census.gov B. This project meets at least ONE of the HUD national objectives listed below (please check all applicable; discussion and definitions available on page 6 of the packet): O1. Benefits low/moderate income individuals/households O2. Addresses the prevention or elimination of slums or blight O3. Meets a particularly urgent community development need C. Check all statements that describe FLOW this project or activity meets one of the National Objectives above: OUM Area Benefit. the project meets the identified needs of UM income persons residing in an area where at least 51%of those residents are UM income persons. The benefits of this type of activity are available to all persons in the area regardless of income. Examples: street improvements,water/sewer lines, neighborhood facilities,facade improvements in neighborhood commercial districts. OUM Limited Clientele:the project benefits a specific group of people (rather than all the residents in a particular area), at least 51% of whom are UM income persons. The following groups are presumed to be UM: abused children, elderly persons, battered spouses, homeless, handicapped, illiterate persons. Examples: construction of a senior center, public services for the homeless,meals on wheels for elderly,construction of job training facilities for the handicapped. OUM Housing: the project adds or improves permanent residential structures that will be occupied by UM income households upon completion. Housing can be either owner or renter occupied units in either one family or multi-family structures. Rental units for UM income persons must be occupied at affordable rents. Examples: acquisition of property for permanent housing, rehabilitation of permanent housing, conversion of non- residential structures into permanent housing. OUM Jobs: the project creates or retains permanent jobs,at least 51%of which are taken by UM income persons or considered to be available to UM income persons. Examples: loans to pay for the expansion of a factory, assistance to a business which has publicly announced its intention to close w/resultant loss of jobs,a majority of which are held by U M persons. OMicro-Enterprise Assistance: the project assists in the establishment of a micro-enterprise or assists persons developing a micro-enterprise. (A micro-enterprise is defined as having five or fewer employees, one or more of whom owns the business.) This activity must benefit low/moderate income persons,area or jobs as defined in previous sections. OSlum or Blighted Area:the project is in a designated slum/blight area and the result of this project addresses one or more of the conditions that qualified the area. OSpot Blight: the project will prevent or eliminate specific conditions of blight or physical decay outside a slum area. Activities are limited to clearance, historic preservation, rehabilitation of buildings, but only to extent necessary to eliminate conditioned detrimental to public health and safety. Examples: historic preservation of a public facility threatening public safety,demolition of a deteriorated,abandoned building. City of Elgin CDBG Application FY 2013-2014 Application Page 19 of 32 D. Project Category(check one): OAcquisition of Real Property ODisposition of Real Property OPublic Facilities and Improvements(e.g.,homeless shelter,water and sewer facilities,flood and drainage improvements,fire protection facilities/equipment,community,senior and health centers,parking,streets,curbs,gutters and sidewalks,parks and playgrounds.) OPrivately-Owned Utilities OPublic Service(i.e.,a new service or an increase in the level of a service ORelocation Payments and Assistance to Displaced Persons ORemoval of Architectural Barriers,Handicapped Accessibility OHousing Rehabilitation OHistoric Preservation OCommercial or Industrial Rehabilitation, including facade improvements and corrections of code violations. OSpecial Economic Development or assistance to micro-enterprises City of Elgin CDBG Application FY 2013-2014 Application Page 20 of 32 3. 1MPAC7.ON A0PtaCA8t:1r GOAL3;N OBJECTIVES The Five-Year Consolidated Plan identifies both priority needs in the community and strategies to address these needs. The need for your proposed project will be determined by identifying how the project impacts upon the adopted Consolidated Plan Priority Needs. Therefore, applications should provide a clear explanation of how the project impacts upon the adopted Consolidated Plan Priority Needs. Greater consideration will be given to projects that provide a clear description of the project with supporting data and methodology of how the project will meet the Consolidated Plan Priority Needs. Please identify the category and activity applicable to your proposal,using that table as your guide: Example: Public Service Activity: Rental Reimbursement OAcquisition of Real Property Activity: Oinfrastructure Activity: Security lock system OAffordable Housing Activity: O Public Servide Activity: OPlanning&Capacity Building Activity: The City of Elgin has identified ten strategic goals to reflect the City's ongoing commitment to the community. Greater consideration will be given to projects that provide a clear description of the project with supporting data and methodology of how the project will meet the City's strategic goals. Please identify ALL the categories applicable to your proposal: OA Safe Community O Quality Housing ONeighborhood Vitality O River as a Resource .O Economic Growth and Diversified Tax Base O Alive Downtown ORecreational,Leisure and Cultural Opportunities for all Citizens O Financially Stable City Government OAcquisition of Real Property O Diverse Management Staff PROPOSED PROJECT ACCOMPLISHMENTS Please briefly describe proposed accomplishment(s)if funding is awarded: (Accomplishments must be described in terms of households served, people served, businesses created, housing units created,jobs created or public facilities undertaken. Example: This program will serve 485 LMI individuals, this program will create 25 jobs,etc.) This project will serve over 250 clients and their families. Of those families 70%are low income individuals. Please answer the following questions: A. What is the total estimated number of persons to be served by this project? 250 B. What is the total estimated number of LMI persons to be served by this project? 175 C. What is the anticipated percentage of LMI persons to be served by this project? 70% City of Elgin CDBG Application FY 2013-2014 Application Page 21 of 32 4. ACTIVITY- DESCRIPTION-Please answer the following questions in the spce provided. A. Provide a detailed description of the proposed activity including ow the activity will address the community need you have indicated. Identify whether the activity is new,ongoing,or expanded from previous years. Removing existing mortise locks and installing new alarm lock pin/prox Networx self contained locksets on 15 doors will assure the security of all client files including all our low income clients,medication and medical equipment. This is a new project. B. Identify who will benefit from the proposed activity(e.g.,homeless,youth,seniors, disabled, et cetera). If designed to benefit persons of L/M income, describe the process you will use to identify these persons and ensure that the activity meets this objective. (An LMi certification form is included in the RFP Packet). Open Door Clinic's clients and all low income clients will benefit from the security locks being installed. We identify low income clients through a software program CareWare. Securing the 6th floor will allow us to meet our objective of confidentiality of our clients and security of all equipment,including medical equipment and any funds stored. C. Identify the accomplishments you intend to achieve with this activity. Provide an activity time-frame/schedule(include start,completion dates,and other significant stages). Please note that the fiscal year does not start until Junel,2013. Open Door Clinic will accomplish securing the 6th floor and all its records, medical equipment and medications. Start date would be July 1,2013 with completion on July 2,2013. City of Elgin CDBG Application FY 2013-2014 Application Page 22 of 32 5. 0RGANIZATI0NAI,CAPA[i7Y: Please answer the following questions in the spce provided. A. Provide an overview of your organization including length of time in existence. Attach a list of current officers and board members with terms. The Open Door Clinic(ODC)is a non-profit organization and the primary HIV/AIDS service agency for the far western suburbs of Chicago. Established in 1977,ODC initially provided services for individuals with sexually transmitted disease(STD)to the Fox Valley areas of Elgin and Aurora.In 1986,Open Door was one of the first providers in Illinois to offer HIV testing and one of the first to have a positive test. Open Door Clinic implemented a Case Management Program in 1989 and in 1990; the AIDS Foundation of Chicago approached Open Door Clinic seeking a west suburban organization to provide home services through the Department of Rehabilitation Services.January 1993,Open Door Clinic began providing medical care for persons living with HIV/AIDS(PLWHIV/AIDS). Open Door Clinic will be celebrating 35 years of service in Elgin at the end of 2012. B. Describe your organization's experience in successfully conducting this type of activity. Identify any skills, current services,or special accomplishments that demonstrate your capacity for success. Throughout Open Door Clinic's 35 years of service to people living with HIV/AIDS the clinic prides itself with keeping the confidentiality of each client. C. Identify the person(s) responsible for program and financial management of the activity. Identify all other persons involved in this activity noting whether these positions are current or new,pending this award. David M.Roesler,current Executive Director and Barbara Cox Harris,Director of Finance(both are current positions) City of Elgin CDBG Application FY 2013-2014 Application Page 23 of 32 D. Identify any other agencies/partners in this activity and define the roles and responsibilities of these partners. N/A E. Demonstrate that the proposed activity is economically feasible and can be implemented in a timely cost effective manner within the proposed program year. By installing the card lock system it can be used at our location and if Open Door Clinic were to ever moved it can be taken to the new location. The installation takes 2 days and can be completed within the program year. F. Oftentimes projects that receive an award of CDBG funding are actually awarded less than the amount originally requested. This requires the submission of a revised budget and a description of how it will carry out the proposed activity with reduced funding prior to the commitment of any funding. Please indicate here whether your proposed activity could be undertaken with a reduced commitment of funding and if so, please highlight how that would affect the scope of services you are proposing. If the funding were to be reduced for this project Open Door Clinic would have to consider eliminating some locking units for the doors on the 6th floor until we could find other funding to complete the project. City of Elgin CDBG Application FY 2013-2014 Application Page 24 of 32 6..FINAN 3A.L.. The City encourages CDBG funds to be utilized as gap funding. A gap is defined as the amount of funding necessary to run a program after all other funding sources have been identified, thus leveraging is very important in the application process. ACTIVITY BUDGET Please answer the following questions in the space provided. You may reference and attach an additional page if necessary. A. Complete the Budget Summary chart. More detailed budgets may be scanned and attached (and are strongly recommended)in support of the proposal. B. Identify sources of leveraged funding for this activity. Include the status of these funds (i.e. cash on hand, grants received, planned fund-raising,etc.). Scan and attach copies of funding commitment letters or other evidence of funding support. C. Leverage-Consideration will be given to the amount of non-CDBG funds committed to the project. BUDGET SUMMARY ¢. .�,�`.?�. -a•• i ,zr '.��,-z' -' - z Pv ?' mac ...'-^ ,a"s'."-. c- mss'. G• ..s� �r�. - ya ? K � � ��L3t11C£ i 'i�@T�Ig2� �? kti , egor�r tl©wn� �� DBG everage_ ui�ds �,y t'9�- t�ta)xf nds ,.7."^`z� mac. „_.,..r-�., .= zs, .t" { f31t�C�S£� � � i, Ss-: �"" s?�.OWff. ..�,._.:�,�'�2 �,t9r,�..'ro�3 ,4'�'_.$'`_�4`a,?.x�< y..i.?�^,u??a��.ern__..,.. .fix "z� y'��;,�-,u-.», °��.,�'��e�5 Personnel's Contractual Services (Specify $26896.28 $26896.28 Elgin Lock&Key Company Rent and Utilities Communications Travel Other(Specify) $1500.00 Cash on hand 51500.00 TOTALS $26896.28 $1500.00 �IflTE Pleases-omplete�udgef=l3eia+l Chart�n page 25+f-person_neS costs are�nctuded+r3youTproposai Grand Total $28396.28 City of Elgin CDBG Application FY 2013-2014 Application Page 25 of 32 BUDGET DETAIL This section provides back-up for each line item shown in the Budget Summary Chart. Please make certain this detailed breakdown is consistent with the Program Budget. Round up to the nearest hundred. Please Note: A job description for each person much be provided. A Note about the Staff/Salary Breakdown: Please show all proposed staff positions funded with CDBG funds that relate to the proposed activity. If multiple staff members have the same position/title,list separately(For example: Counselor, 1,Counselor 2). Use the additional space at the end of this document if necessary. You must submit job descriptions with your application for each position title identified below. 'v' o►��€it7�".� ��`�s -�,..,� � �ArJ;� ,��✓�, >�.�� �-�x.��`ss .� ��in�sE�x st �= X = X = X = X = X X = X = A. Oftentimes projects that receive an award of CDBG funding are actually awarded less than the amount originally requested. This requires the submission of a revised budget and a description of how it will carry out the proposed activity with reduced funding prior to the commitment of any funding. Please indicate here whether your proposed activity could be undertaken with a reduced commitment of funding and if so, please highlight how that would affect the scope of services you are proposing. If the funding were to be reduced for this project Open Door Clinic would have to consider eliminating some locking units for the doors on the 6th floor until we could find other funding to complete the project. City of Elgin CDBG Application FY 2013-2014 Application Page 26 of 32 in order for your application to be accepted,in addition to the application itself,your organization must submit the following items to the City of Elgin Community Development Department no later than 5:00 PM on FRIDAY,DECEMBER 14,_2012. OAn original application with all questions completed (single sided, not bound) of the completed application. (Only the original must include the requested support documents such as the articles of incorporation and the current list of your Board of Directors.) OThe following attachments/certifications: (if you have not submitted an application in the last two years OR if the information has changed) OArticles of Incorporation OArticles of Incorporation OCurrent List of Board of Directors OCertified Organization Audit/Financial Statements of most recent year A. Copy of OMB A-133 Audit(Required if$300,000 in aggregate Federal funds expended),or B. Financial statements audited by a CPA (only if not qualified for A-133,)or C. Profit and Loss Statement for most recently completed fiscal year and General Ledger printout(only first time applicants or those who do not meet above criteria may submit) IRS 201(c)(3)Designation Letter(Pending letters will not be accepted) O OCurrent Fiscal Year Agency Budget,including all funding sources OJob Descriptions per budget detail. OAn Executed Statement of Applicant Form. OAn Executed Signature Authorization Form. OConflict of Interest Disclosure Form. I hereby confirm that this packet tains all materials required. City of Elgin CDBG Application FY 2013-2014 Application Page 27 of 32 `.�. - sr� nII�aT�o�A�lPii�c�►ii�r ".� " r r The undersigned acknowledges the following: 1. That,to the best of its knowledge and belief,all factual information provided is true and correct and all estimates are reasonable. 2. That no revised proposals/applications may be made in connection with this application once the deadline for applications has passed. . 3. That the City of Elgin may request or require changes in the information submitted, and may substitute its own figures,which it deems reasonable for any or all figures provided. That the applicant will participate in required interview for project assessment and cooperatively assist in the review process. 4. That, if the project(s) is recommended and approved by the Mayor and City Council,the City reserves the right to reduce and/or cancel the allocation if federal entitlements are cancelled,reduced,or rescinded. 5. The City of Elgin reserves the right not to fund any submittals received. 6. By submission of this application,the organization agrees to abide by the federal regulations applicable to this program. 7. That,if the project(s)is funded,the organization agrees to abide by the City's locally established policies and guidelines 8. That past program and financial performance will be considered in reviewing this application. 9. That services are to be provided at no cost to citizens during the grant period. All program income (i.e.: fees, repayments, foreclosures,etc.)must be remitted to the City. 10. That,if the project(s) is funded,the City or a designated agency may conduct an accounting system inspection to review internal controls,including procurement and uniform administrative procedures,prior to issuance of payments for projected expenditures. 11. That,if project(s)is funded,the City will perform an environmental review prior to the obligation of funds. 12. That, if a project is funded, a written agreement that includes a statement of work, records retention and reporting, program income procedures, local and federal requirements, circumstances that would trigger grant suspensions and terminations, and reversions of assets would be required between the organization and the City. 13. That a project's funding does not guarantee its continuation in subsequent action plans. 14. Provide written signatory authority from the organization's governing body indicating who can execute contracts and amendments on its behalf. 15. Agrees to abide by the City of Elgin's Conflict of Interest policy. Items of concern would include staff members serving on the Board of Directors,staff members'families serving on the Board of Directors,and other matters that may give the appearance of a conflict of interest. PENALTY FOR FALSE OR FRAUDULENT STATEMENT U.S.Code Title 18,Section 1001, provides that a fine of up to$10,000 or imprisonment for a period not to exceed five years,or both,shall be the penalty for willful misrepresentation and the making of false,fictitious statements, knowing same to be false. City of Elgin CDBG Application FY 2013-2014 Application Page 28 of 32 By signature below,the applicant acknowledges the above in its name on this 12th day of, December 2012. Open Door Clinic of Greater Elgin Name of Organization By: (Signature) Executive Director (Title) City of Elgin CDBG Application FY 201 3-2014 Application Page 29 of 32 IN A C 31G1VATiiRAli1HORIZATiONRM The Board of Directors of Open Door Clinic does hereby resolve that on December 12,2012 the Board reviewed the Application for Community Development Block Grant Funds to be submitted to the City of Elgin Community Development Department for funding consideration for the fiscal year 2013-2014 and in a proper motion and vote approved this application for submission. The Board further certifies that the organization making this application has complied with all applicable laws and regulations pertaining to the application and is a non-profit organization,tax-exempt and incorporated in the State of Illinois. Open Door Clinic (Name of organization requesting CDBG funds) hereby proposes to provide the services or project identified in the Scope of Services in accordance with this application for Community Development Block Grant Funds. If this application is approved and this organization receives CDBG funding from the City of Elgin,this organization agrees to adhere to all relevant Federal, State and local regulations and other assurances as required by the City. Furthermore, as the duly authorized representative of the organization,I certify that the organization is fully capable of fulfilling its obligation under this application as stated herein. I further certify that this application and the information contained herein are true,correct and complete. I also authorize the following person(s)to have signatory authority regarding this grant: David M.Roesler Executive Director Name Title Barbara Cox Harris Director of Finance Name Title President/Board of Directors(or other authorized person) December 12,2012 Date PENALTY FOR FALSE OR FRAUDULENT STATEMENT U.S. Code Title 18,Section 1001, provides that a fine of up to$10,000 or imprisonment for a period not to exceed five years,or both,shall be the penalty for willful misrepresentation and the making of false,fictitious statements, knowing same to be false. Ciry of Elgin CDBG Application FY 2013-2014 Application Page 30 of 32 CONFLICT OF INTEREST The standards in OMB Circular A-110, Subpart C, provide that no employee, officer, or agent shall participate in the selection,award,or administration of a contract supported by Federal funds if a real or apparent conflict of interest would be involved.Such a conflict would arise when an employee, officer, or agent, any member of his or her immediate family, his or her partner, or an organization which employs or is about to employ any of the parties indicated herein,has a financial or other interest in the firm selected for an award. The CDBG regulations at 24 CFR 570.611 and HOME regulations at 24 CFR 92.356 provide that no person who is an employee, agent, consultant,officer,or elected official or appointed official of the recipient or subrecipient that are receiving CDBG or HOME funds and(1) who exercises or has exercised any functions or responsibilities with respect to activities assisted with CDBG funds; or (2) who is in a position to participate in a decision-making process or gain inside information with regard to these activities, may obtain a financial interest from a CDBG-assisted or HOME-assisted activity, or have any interest in any contract, subcontract, or agreement with respect thereto,or the proceeds there under,either for themselves or those with whom they have family or business ties,during their tenure or for one(1)year thereafter. A disclosure of the nature of any perceived or actual conflict must be made prior to the execution of agreements utilizing CDBG or HOME. IF NO CONFLICT EXISTS,COMPLETE THE FOLLOWING: OI certify that no conflict of interest exists between the City of Elgin and(name of organization) Open Door Clinic O1 certify that no conflict of interest exists between the subcontractors of the(name of organization) IF A POTENTIAL CONFLICT EXISTS,COMPLETE THE FOLLOWING: O1 certify that a potential conflict of interest may exists between the City of Elgin and(name of organization) O1 certify that a potential conflict of interest may exist between (name of subcontractor) and(name of organization. Describe the nature of the conflict of interest below. Identify the individual,employment and the conflict or potential conflict,and their affiliation with your organization. Signature of Authorized Agency Official and Date City of Elgin CDBG Application FY 2013-2014 Application Page 31 of 32 OPEN BOOR CLINIC 2012 Budget_ TOTAL j ! i Jan-Dec 12 ':Ordniary Tncoine/Expense — ! flricoine 1 — ! I j Donations 1- _ TCi_c-ag o Comm_u_r - T.ru_st_ __f-- 0v00 ! ;Broadwav Cares 5,000.00 - �- ;AFC Cvcle Grants 0.0o ! ij Foundation Donations EFS,Foundation— _ -�-T_ _0.00 'E undation Donations--Other 7,000.00 I ! !Total Foundation Donations 7,000-00 Emergency Assistance Reimburs i 2,500.00 i Grand Victoria Foundation 0.00 :In Kind Donations_ _ +i- 0.00 {Restricted Private:Donation _ 0.00 r i !Unresiricted..Private Donation_ 0.00 iMernorial Donations -� I jUniestricted.Private Donation-Other 10,000.00 ! j ' Total Unrestricted Private Donation 10,000.00 'Total Donations 24,500.00 ;Government Funds &Grants County Township Funds ^—T __._-_---- -............... Aurota Twsp 708.MH Board j 2,500.00 .Aurora Township y- 0.00 ! Hanovet 708 Board 5,000.00 ---- _ _Kane County Health Dept -- - -�--T- - - r Hep C — 0.00 '; i-------- — { STD Clinic 0.00 f Pane County Health Dept-Other 0.40 ` ;Total Kane.County Health Dept 0.00 ^� - iSalud Latina/Latino -- 0.00 {. !�i jCounty-/Township Funds-Other 0.00 i ',Total County/Township Funds i 7,500.00 - ;Federal Funds — - - jTteatmenbCoordinator- { 0.00 I j ;AFC Case Management 243,815.00 �- 'AFC Consortium 54,000.00 'AFC Consortia Rollover Funds. 0.00 i Chicago Department of Healt_fi•—_ 32_2,419.00 :Chicago Dept of Health MAI - I ---0.0.0 !�. 1 CDPH Rollover { 0.00 !HRSA RW PART C 361,246.00 - -- - --t---�--- ------ — — - - ._....... {Federal Funds-Other s 0.00 i Total Federal Funds 981,480.00 I _�-.-.----- OPEN DOOR CLINIC i 'State of Illinois Funding. ^ Public Health Institute of Metro Chicagi 0.00 j IDPH Other 0.00 J-1..__.. ;TotalIDPH _ 0.00 iIL Dept ofPublicAid i 0.00 JL Dept of Rehab Services— — ! 114,000.00 Jf— -.Illinois Public:Health Assoc _ 99,324.00. State of Illinois.Funding-Other 0:00 (Total State of Illinois Funding 213,324.00 I ; ,Government Funds&Grants`-Other 0,00 i 'Total Goyernmcnt.Funds_&Grants 1,202,304.00 j jProgramincome B Income ! ,Waived Co-Pays 2,460,000.0_0 j —j-- 1340.B Mgmt Fees — — 0.00 Drug Costs for 340 B Program r— 0.00 0 ncome_Other — ITotal 340$Income---- -- — -- -2,460,000.00 -� 1 (Psychiatric Program Income 3,650.00 j ;Private Insurance Reimbursement 24,395.00 Program.Fees Charged i -�- -{ (Rapid Tests _ i ;,920.00 IProgram Fees Charged-Other 31,000.00 —.�- Program.Fees Charged 32,920.00 !Medicare Reimbursements 42,000W ':—;Medicaid Reimbursments 32;500.00. _ —.-T- - 1__> 3rd Party Invoicing _ —-- 0:00 ;Progcain Income-Other ! 0.00 j ;Total Program Income j 2,595,465.00 ii .Fund Raising&Special Events__ I i !Muddy Budd;-'First Goagtegauonal.Church ofCi 6,000:00 Mefissa Manchester 0.00 ;Pa D _ - tty_ uke uke 0.00 = -_� '2010 Mailing 0.00 ;Cabaret for a Cause 0.00 jAIDS Walk ' 5;OQ0.00 I I Idly Tomlin March:22nd 0.00 -,--i—t- - -- ---— -— 3 !All Things Chocolate Ad Sales 150:00 !Aucfion.Item Site — _ i -8,00000 i ;Event Ticket Sales 11,100:00 'Raffle Ticket:Sales 3,500:00 .Sponsors _ _ _ 2;500.00 Alf Things Chocolate=Other i 700-00 _ 25,950 ITotalAlt•Th Chocolate j .00 OPEN DOOR CLINIC 'Special Event s _ _ 0.0_0 f-1World AIDS Day Mailer _ _ — - 775.00 Tund Raising-&Special Events-Other 1 500:00 TOtal Rind Raising&Special Events — 38,225.00 iUnited-Way I i ;United Way EE Donations _ 0.00 j Tox:Valley United Way I 5,400.00 Chicago United Way _ 0.00 ! I !El� Wa n United _ _ T T �- 3 0.00! i _ I ; i IMetro.Chicaago United Way—� 0.00 !St.Charles United.Way ! 2,250.00 4--j, -• _..--- - -- - I United:Way-Other 1 0.00 i ITotai United Way — 7,250.00 _ 1Other Income _ -1 ! ! �Employee Share Benefits 20,628.00 Research Income — 0.00 —�— ! !Miscellaneous Revenue i 0.00 Other Income-Other 0.00 I I ` ''Total Other Income 20,628.00 IToW.Income 1 3,888;372.00 ~- iGross Profit 1 3,888,37200 _] f iExpense i � -----Fr gram Expenditures :Technology Expenses j T j s Other _ _ j 2,000.00 1 Server Expenses-- _-- 0.00 —_! i Netevork Expenses_ 0.00 y ! 1 Smartphones 0.00 ' I ;`Workstation Ex eases 1. 0:00 ;Electronic Medical Records Expenses ! 0.00 —--�--- I ! j ;Computer..Expenses — 6;204.0_0 Technology Expenses--Other 799.00. --j—}� 'Total Technology-y Expenses — i 8,999.00 i —!Contract Services (Co—nsultants i . 1 H Consltant _ 8,000.00 ;_Resource and Development Consultant> 4,000.00 1 (Technology Consultant i 4,000.00 —� —~ iExecutive Goasultant 4,000.00 ;Fiscal Consultant 4,000.00 I Consultants.-Other 4,000.00 i I Total Consultants _ 24;000.00 I j ! 0.B Program Expense j 1 B X340 :Program Drug Costs 1 1,224;000.00 1340 B - i ! ! 6 i340.B Mgnit Fees_ I 548,400.00 i 1 340 B Co-pay Expense ; 114,447.00 OPENDOORCUNIC ";34.0'B Proaram Expense-Other 0.00 'Total 340 B Program Expense 1,836,847.00 C 8,649.36 bevelopment Consultant 4,000.0.0 I.Incentives 0.00 'Accounting Services 0;00 lAudit.Fees 6,910-Q0 13rd Party.Billing Fees 7,178 tConsulting Expense 0.00 i Dentists 37,000100 boctors 80,629,00 T*Services 15,000,00 iMedical Waste Disposal Interpretor 0.00 Laboratory Fees 'Hep C:Lab Fees 0.00 'Laborat ry Fees-Other 98,136.00 aboratory Fees 98 1-36-M lNufrition Services 0.00 oner istipends 3,26-1-00 'Contract Services-Other 0.00 ;;Total Contract Services 294,76236 Trograrn Salaries 1%peer to Peet. rse Practioner El' 78,000.00 iNu I 'Coordinator of.Behavior Health Pan Time RN 0.00 jPatient Coordinator 47,108.00 AdministrativeAssistant Director of Finance 51,044.00 'Assistant Director 6.2000.00 ICertified Nurses Msistant 0.00 i 'Case Managers Salaries Michelle Villar Salatv Expense fjoanna:Ruiz Salary Expense j Sharon Maracb Salary Expense Jennifer Genzlinger Salary,Expense �otaj Case Managers�Salaries 228,955.00 ! ' ' ` | ` / ` � ~ ' ` ' / ^ ; ^ � | � / � OPEN DOOR CLINIC j Director of Development _ 28;000.00 i iDitector Sala Case M gm t 1 _ 60,000.00 - !Elgin Patient Coordinator —22000.00 ;Coordinator-Latino Services 42,925.00 I -! IMedical.Assistant - 27;040.00 ;Aurora HIGNurse 50,000.00 I 'Elgin HIV Nurses Salaries 52,530.00 _�_- _. __.._0 i I ;Nurse Practitioner-Aurora 65,000.00 i }Officer Salary __ 81,500.00 I Program Salaries-Other ! 39,140.00 i _ ITotal:Prograrn Salaries j 1,017,6,4200 _--- i Supplies&Equipment_ i I Meeting Refreshments I 2,000.00 j O Tice Supplies 3,500.00 -;— ---r--:.— - --- -- 'Medications/Supplements 38,000.00 j---?- Medical Supplies 16,47600 — —:__- 'Program:Supplies _ ;Program incentives-Client _ i 500.00 'Program Supplies-Other $ 34609.00 I ' I i 'Total Program Supplies 89,585.00 i 1 Su�- pplies&Equipment- — 0.00 IT.o"tai Supplies_&.Equipment j 95,085.00 -'Other.Program Expenses f j ontributions 0.00 { i jDues and Subscriptions 500.00. - -.-- - _ I j 'Fund Raising Expenses 3,575.00 i I First Congregational Church of Geneva 1 0.00 Imo_ ;Melissa Manchester- 0.00 - - t Patty Duke Expenses 0.00 i ,AIDS Walk.Expenses 174.00 Cabaret for a Cause 'Wor1il AIDSb'ay _ ! 0.00 All Things Chocolate 14,637.50 ; j j—� Giant Writing -�- 0.00 ;Marketing _ 0.00 Event Cost. _ _ j 0.00 -- T�- .Fund Raising:Expenses-Other -- ' 0.00 ;Total Fund_Raising Expenses ; 18,212.50 j jPostage and.Delivery — 2;3'16.00_ j _, ;Training;Expenses__- _-- 15,000.00 il:in:collected Clie_nt.Fees 0.00 IMiscellaneous Admin Exp. _ 0.00 ;Other Program Expenses-Other 0.00 !Total Other Program Expenses 36,028.50 �jPromotion _ t Internet Expense --�- 0.00 . ^ OPEN DOOR CLINIC *sified Ads !Printing and Reproduction 4000.00 �Telephone/Communications 32,773.00 1,ToW Promotion 37,2173.00 Conferences*Workshops -meals 1,813.00 'Commercial Travel 6,280.00 iStand against Cancer 0.00 jEduc-Confhce-.& Workshop Fees-Othi 11700.00 Liability Insurance I-Auto Liabili Insurance 261.00 1property/Content Insurance 669.00 [Director/Officers'Liability Insurance 5,750.00 Rp=jnnkj�.]�Lih Insurance 19,164.00 ILialAlity Insurance:-Other 0.00 Total Liability Insurance -Rent 59,556.00 lutilities g Fuel 0 00 Iwate, 0,00 !Utilities-Other 4,900M ;Total Utilities 4,900.00 'Occupancy Other 0.00 I'Total -Occupancy 99,719.00 1p rogram Expenditures-Other 0_00 'Total Program Expenditures 3*,531,088.86 1p roll Benefits&Taxes -Group Health I surance 1 401(1P EmployerMatch 0.00 iVision insurance 1,721.28 Health Insurance 101,354.00 'Life Insurance 16,086.00 lGroup Health Insurance-Other 0,00 Total Group Health Insurance 149,60028 16ther Employee Benefits i / i , � - - ' OPEN DOOR CLINIC j { Physician Assistance Liability Insurance j. 2,29.1.00 .403($)Plans J0.00 Par + 2,70000. I -Other Ernployee Beriefits_Other 0.00 (Total Offier;Employee Benefits 4,991:00 - ;Payroll Taxes ----- — __. jEmploy ax er FICA T _ __ _ _ �— 77,850.00 j I j unemployment Comp Taxes 13,891.00 �Payroll.Taxes-Oilier 0.00 T +TT oW Pavroll Taxes -~ — i 91;741.00 :Wothman's-Compensation Ins _ 6;004.00 Payroll Benefits&'Taxes-^Other 0.00 :Total Payroll Benefim&:Taxes 252;426.28 IUncategodzed Expenses 0.00 Tofai E ease 3,783,515.14 jNetOrdinary Income 104,856:86 a ELITE MANAGEMENT 164 DIVISION ST. SUITE 705 ELGIN,IL. 60120 1-847-697-7799 1-847-697-7798 FAX 12/11/2012 TO: CITY OF ELGIN FROM: FRANK HALSEY RE: BUILDING AT 164 DIVISION ST. DEAR SIR, PLEASE FIND ENCLOSED MY PERMISSION FOR OPEN DOOR TO INSTALL NEW LOCKS ON THEIR DOORS WITH OUR REVIEW OF THE LOCK AT 164 DIVISION ST. IF YOU HAVE ANY QUESTIONS, PLEASE CALL ME AT 847-697-7799 OR 815-757-4347 CELL). FHALSEY F PROAypr ELGIN KEY & LOCK COMPANY, INC. PROFESSIOAwi MEETING YOUR SECURITY NEEDS SINCE 1933 SrRWCE ILLINOIS LOCKSMITH LICENSE NO.192-000132 www.e gm ey.com 201 NORTH SPRING STREET ELGIN, ILLINOIS 60120-4197 (847)742-7006 FAX(847)742-1315 ESTIMATE Pd16100 DATE: 8/22/2012 Company: Open Door Clinic Phone: 847-695-1093x18 Attention: Barbara Cox Harris Fax: 847-695-0501 Job: 6th floor email: barbc@opendoorclinic.org Location: 164 Division Street#607 Cell: 0 We hereby submit specir►cations and price estimate for the following Parts& Equipment: Remove existing mortise locks and install Alarm Lock Pin/prox Networx self contained locksets on fifteen doors total. Estimate includes 25 cards, and initial programming of all the Networx entry units. Install 1 IM80211 wireless network hub to communicate to all the doors. Open door Clinic will need to supply an intranet connected computer for software installation to program and maintain the entry system and to download audit trail and lock information. After initial set-up, this wireless system controls all programming, lock and audit trail functions from any enabled computer having access. Note: This breaks down on average to approximately $1793.00 per door. On average the elimination of each additional lock will reduce the quote by approximately $1525.00 or so. If six or less locks are required I will submit a revised quote. TOTAL ESTIMATE OF PROPOSED JOB: $26,896.28 All materials guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Estimate valid for 90 days.50%deposit down at time of order for all special order items. ESTIMATE SUBMITTED BY: Vince DATE: 8/23/2012 APPROVED BY: DATE: •�m+'Jfj Department of tile IRS lnternal R ovenue Sery ice P.O. Box 2508 In reply refer to: 0248421964 Cincinnati OH 45201 Feb . 02, 2009 LTR 4168C E0 36-2899274 000000 00 000 00013228 BODC: TE OPEN DOOR CLINIC OF GREATER ELGIN 164 DIVISION ST STE 607 ELGIN IL 60120 022852 Employer Identification Number: 36-2899274 Person to Contact: MS. MITCHELL Toll Free Telephone Number: 1-877-829-5500 Dear TAXPAYER: This is in response to your request of Jan. 22, 2009, regarding your tax-exempt status . Our records indicate that a determination letter was issued in JANUARY 1977, that recognized you as exempt from Federal income tax , and discloses that you are currently exempt under section 501 (c) (3) of the Internal Revenue Code . Our records also indicate you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a) (1) and 170(b) (1) (A) (vi) . Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106 , and 2522 of the'Code . If you have any questions , please call us at the telephone number shown in the heading of this letter. Sincerely yours, Michele M. Sullivan, Oper. Mgr. Accounts Management Operations I Illinois Department of'Revenue Office of Local Government Services Sales Tax Exemption Section, 3-520 . 101 W. Jefferson Street Springfield. Illinois 62702 217 782-8881 March 13, 2009 OPEN DOOR CLINIC OF THE GREATER ELGIN AREA SUITE 607 164 DIVISION ST ELGIN IL 60220 We have received your recent letter, and based on the information you furnished, we believe OPEN DOOR CLINIC OF THE GREATER-ELGIN AREA of ELGIN, IL is organized and operated exclusively for charitable " purposes. Consequently, sales of any kind to this organization are exempt from the Retailers' occupa- tion Tax, the Service Occupation Tax (both state and local), the Use Tax, and the Service Service Use Tax in Illinois. We have issued your organization the following tax exemption identification number: E9970-8094-05. To claim the exemption, you must provide this number to your suppliers when purchasing tangible personal property for organizational use. This exemption may not be used by individual members of the organization to make purchases for their individual . use. This exemption will expire on April 1.•2014, unless you apply to the Illinois Depart- ment of Revenue for renewal at least three months prior to the expiration date. Office of Local Government Services Illinois Department of Revenue STS 749 (R-2/98) tL-492-3456 11-0000047 File Number 5107-063-1 ` a _ o r O e- s' 'D9 To all to whore these Presents Shall Come, Greeting: I, Jesse White, Secretary of State of the State of Illinois, do hereby certify that OPEN DOOR CLINIC OF GREATER ELGIN, A DOMESTIC CORPORATION, INCORPORATED UNDER THE LAWS OF THIS STATE ON JANUARY 17, 1977,APPEARS TO HAVE COMPLIED WITH ALL THE PROVISIONS OF THE GENERAL NOT FOR PROFIT CORPORATION ACT OF THIS STATE, AND AS OF THIS DATE, IS IN GOOD STANDING AS A DOMESTIC CORPORATION IN THE STATE OF ILLINOIS- In T'estimondy. Whereof, I hereto set my hand and cause to be affixed the Great Seal of o the State of Illinois, this 20TH day of FEBRUARY A.D. 2013 Authentication#: 1305101714 Authenticate at http:/Iwww.cyberddveillinois.com SECRETARY Or STATE Gertzcafe Number a� OPEN DOOR CLINIC OF GREATER ELGIN 17th ,da January .19 � '�, GENERAt NOT FOR PROFIT`CORPORATION ACTJ� ,�jrkailea! ui�.�T, J �t�vvicr Alan J.Dixon Ji?oui`7kerejora-(If / ',c zck A4Z ,q / aurriu�fl�ir�ir�is�xauya!a/�dcel° i *ot� teg� 94 9dp - a� 17-th January Qp�19z� �tEA4 . . 4 SECAETAW OF STATE - 91 f F ill ig Pee"fZ&I FORM NP-29 I ARTICLES OF:INCORPORATION UNDER THE C P7EItA7:"NOT rok: Psom co8Pt3ft noN ACT (Then Artkiij Must se Filad in'Oupiiaate). . .• L„ _ _ (Oo N t.W-Ht.In`This sgaQe) . pate Paid -�.]-'77 " Filing Fee f I-rvt To'ivIlCfiilEL J. xoWLEiT,Secretary,ot"State,.Spriagfield,Illinois. tee" /burr 071 We.-the undersigned. y Adam Number :street city state 224 Heal Elgin Illinois C tarl : es'West. y BereniM Naue" 66 Wren Road Carpentersville Illinois James ii.�Orklaed 660 "Logan Avenue Elgin -Illinois i i beiag".natuial persons of the age of-twenty-one years or more and cidieas of the United Suter, for the purpose of training a Corporation on the"General Not For Profit Gorporatioa"nu"of the State of idinois do heacby adopt tl>e iaaviing Mercier of Incoipomnon: 1. Ttina¢siie of ire corporation OPEN' DOOR CLINIC OF GREATER ELGIN 2.-The period of duration of-A_corporation is: perpetual " @LS era.•wm—r•a•Whale ee:m,r p( y- 3 Tbe:addl=of.:its inhW.Registeted Office in the slate"of uitaois is: "1645 Larkin Ave.,./P:O.Box'68:7 . strus.ia-ii:e. Ci"ty.,. .. -nF Elgin'. _t66QI20) County of Kane and / ere rmei the time>df its iaiwal":Rsgistcied"Agent a sold Addre7i a James M. Kirkland.. 4. Ttie;&ai Boaid'of:liircuors"chall.br �Y in number-their nairia Pad addreumb=iug ai.fotiows: neat r.a_euee) truest: city state Charles West 224 Healy Elgin Illinois Kathy Madden. 478 Mary P1..,Apt. 1 Elgin" Illinois Margaret Clute. 42"1.. .Coor>er Elgin Illinois .Bob Bergman. :213.:..Jervey"Lane Bartlett. " Illinois Dave Brown- 9:71 Meadow=Lane Elgin" Illinois S. The otuvost:or ouniasct Gtr .hi'+,et:' SECTION I: The ConpoTation is organized exclusively for scientific, charitable,. religious, testing. for public safety, and: educational purposes:," and spec2fically in-furtherance thereof, to: provide facilities and non- medical" .personnel only.. _ A. . To carry"on coordinated efforts (including assisting one or tgore consulting:, licensed 'physicians) `to combat sexually transmitted dis-eas.es. . Br: To educate and counsel the public about the. seriousness of these-diseases:and" the .importance of proper treatment, C. To provide a positive and inten"s ve follow-up "program for all individualsi'treated. for sexually.transmitte"d disease or in: contact with' sexually transmitted' disease patients. D To serve as a resource and referral center fo.r area: physicians and, educational ins t-itut ions. NOTE: The .corporation will not en"gage, in the practice of medicine'or performance "of any of the functions of a licensed phys"ician,: " C potation is organized exc''lusiveLy for scientific, charitable., religious, testing .for public safety, "abd':educational purposes, including ." for such"ipurposes; the making of contributions "to. orgarizatkons that. qualify as exempt: organizations under Sec".. 501(c)('3)" of 'the Internal Revenue Code and its "regulations as."it"now exists or as it may"there-after be amended. � -SECTION III: No part of' the net earnings of the. corporation shall inure to the benefit' of any director .or .officer of the corporation, or any private individual . (except that reasonable compensation may be paid for services rendered to or for the corporation affecting one or more of its purposes,: and no director or- offi.- cer of the corporation., or any private individual, shall be entitled to share i in the distribution of any of the corporate assets on dissolution of the cor- poration.) No substantial part of the activities of the corporation shall be the' carrying on of propaganda, or' otherwise attempting. to "influence legisla tion, and the corporation shall not participate in, or intervene in (including the publication or distribution of statements). any political campaign on behalf'-: of any candidate for public office::. SECT ION°IV: Notwithstanding any other provision of these articles of incorporation„ 4. the corporation shall not conduct or carry on- any activities not pertnitted: to —be-conducted-or--carrie'd-on7-tiy" ari or'ganiiaEion exempt from taxation under Sec. 501(c)(3) "of-the-Interna-1-Revenue Qode-and-its regulations as they"now exist or as they may hereafter be amended,. or an organization, contributions to which. are deductible under. Sec. I70(c)(2) of the Internal Revenue Code and its regular rj=s_,M they now exist _or as .they may hereafter be amended:* T. *See Rider Attached:: fTIOTEt. 'Ally npecisi pfcvlims audio a or permitted by a-att te.to:be contained in the A,nWes of;licotpgiatlaa�, cuy bo iaserud ab&s ). (INCORPORATORS MUST SIGN*BELOW).- l a,.,tral 0 ems— . . ar es n c : Lwrporaion ACKNOWrEDGMIENT STA E`:&MUNIOM l County of`.. Kane 1ss. I. the undersigned._a- .... a.Notary Tub&do hereby certify that on the 15th;.. d y oI pecembei 19:76 Charles West, Berenice Naue, and Jaihes M. .KirT1an" .. petsonally"appeared before ee,and being fim dniy swbrn by me aeveraIl7;acknowledged that they signed:the foregoing dxnnten4.in the rapeetfve_.csyatitits therein set forth and dmiared that the statements themn eoa"ed:an t ,%SIN WrrNESSeWHEREOP:I have h&amlo-set my hand.and:ual the day.and year above-wriam wftiw s�iiia' y�lirt fan -1 ?rnoT o t.x Z . v 2 z yVV O ra r Q Z 0. f. R IDER- ATTACHED TO ARTICLES OF INCORPORATION UNDER THE GENERAL NOT FOR ! PROPIT CORPORATION ACT - OPEN DOOR CLINIC OF GREATER ELGIN James Entwistle 1.491 Chestnut Elgin 27,71' 1 ' Bob: Deem 4 South Gifford. Elgin 1111 j4ary Densch 1165 Cedar Avenue Elgin I11 of taes Kirkland 660 Logan Avenue_ Ja Elgin Illinois : Pat Miller 326 River Bluff Rd. Elgin Illinj �, �_ Clint Munch 101:Douglas Elgin Illinois. WOO Retm Naue-::.-. :..-66-.. Wren Road Elgin.: IIIii � 1• _ Shirley Rauschenberger 637 Prgspect :. ..Elgin Illi$OCtt�t' R'on: Rimovsky 803 Lincoln West.'Chicago Illinois Chris- Virg-il 143 Williamsburg Bartlett Illinois Mary DVora-k Patricia Lane Rartlett T.Il nois _RIDER ATTACHED TO ARTICLES OF INCORPORATION UNDER THE GENERAL :NOY FOR PROFIT CORPORATION ACT - -OPEN DOOR CLINIC OF GREATER ELGIN ' SECTION 'V:: Upon the dissolution of the corporation- or the winding up of its affairs , .tFre. assets° of the corporation shall be,._ distributed exclusively to charitable, ,._religious,, scientific, testing for .puUlic .safety,_, liter.ary,.. or educational organizations which, would ..then quali-fy .under the provisions -of Sec. 501(c)(3) of the Internal Revenue Code and its re 16- as they now exist or as they, may her..eafter be amended. SECTION: VI: The corporation shall nor, except to an insubstantial degree; engage- tn- ally activities or exercise. any powers that are not in furtherance of the primate purpose of the.:: c;orporation,: Lt zs. orgarized pursuant to the Illinois General Not for Profit Corporation Act and does not contemplate: percuni'ary gain or prOflt to`its d1req:tdr-s, officers, `or memberg thereof, .Or any priS73te ritlividtials:,. and is organ;i ed_ for not for` profit purposes.. JESSE.MiTE,SECRETARY OF STATE DOMESTiC[FOREIGN CORPORATION. ANNUAL REPORT I GENERAL NOT FOR PROFIT FILED CORPORATION ACT j Filing Fee:$5 MAR 0 7 2005 Mate;add penalty of$3 $gCJES E wo r srtisl --_ —�_ CP037187T -76 Do.Not Write Above This Line-. Year.z-51.Fle#_ 1. . U*ation Name 0 P46 !0OL.i2 :.. .*j 4r— C—Y— C—(- J I gRegsterd gen d M' o CS a irRegistered Agent b j Registered Office ( i 5 ij4-_-V— Registered Office I G 4 121 V S 1 o N Ar R b s T City,IL,ZIP,County EGra, Z /ZO — Kwe City,IL,ZIP,County 1=LGI N , r r- eo 1 z o . KNVI i CLWDIS Date of Incorporationit]uatification: ( �l !97 3(b). Stale of Incorpoia6on Z 4.) The narrinwid respective addresses of the corporation's officers and directors are: NAME OFFICE I NUMBER&STREET CITY STATE Zip oc' gJn)r t1G ProsidaM 2L o� WAIC AS Secretary _reV ra1GnA . alle Treasurer ZoS 2 ✓C CV -r �Jcpa Director 1 2 tf UP&L- =C_ iAvo w Director Mowzsw LAV457 -""'u 7=C. 3 re Director I 3"2a, C/ Ctc E ilk-' NOTE: List all officers and directors: ova or list them on an:additional sheet Illinois coipvietions most have three directors. 5. The following is:a brieistatemenf-of the character of the affairs wtiictf the corporation.is actuall conducting: 6. is,this corporatona Condolniniuin Association as established underthe'Cohdoininium PrapertyAct? Yes O No Id .. (Check One) isthis corporation a Cooperaflve Housing Corporation defined-in Section 216 of the internW Revenue Code of 19547 Yes 0: No 01 (Check One) fS.:this carpbrat(on a.Homeaiivner's Association whtde.,adminislers a.common=interest comrnugtty as'deflried In subsection(c).of=Section 9 102 of the-Code of Civd Procedure? Yes:, -,p- .. No* (Check One), T. The-address;fncludtrig sweet and nurnber of the,corporation's:portcipat office: (/Jitmberarid sneer) (ptjyj_ (slate) (ZIP code). read mwmQ rt before w ,ILL'. ( . othaeYS:Slgrtarure) (relej (Date)- UrxW the penalty:or perjury and as an atithgized officer.I declare thatttus amwat: report,PXWMI to.provisimm of the Gen crat:Not.For,P�d Corporaffcn Act.has been examined by too and Is,to the best of. my,Wiowledgeand be6e1,tine,correct,and cornplele: C-54:21 ITEM 8 M08T 's , 81.0 ED File Number- 5107-063-1, U �J To all to whom these Presents°Shall Come; Greeting,` 1,Jesse White,.Secreta?y of State of the State of Illinois;: do hereby certify that I am the keeper of the records of the Department of Business Services. I certify-that THEFOREGOING AND HERETO ATTACHED IS A TRUE AND`CORRECT COPY CONSISTING OF 5 PAGES, AS TAKEN FROM THE ORIGINAL ON FILE.IN THIS OFFICE FOR OPEN DOOR CLINIC OF GREATER ELGIN.****** In Tagtimoniy. heref :::hereto set my hand and cause to be affixed the Great .Seal of the State of Itlrno�s, this= 6TH day of JANUARY A.D. 2012 Authenricarion#:1200600247 Audienticaic ai:httpi9lwivty:cyberdriveillinois.tom SECRETARY OF STATE I Open Door Clinic of Greater Elgin Audited Financial Statements Years Ended December 31, 2011 and 2010 � � Table of Contents Independent Auditor' -------------------_____—'___-------.l'2 � Financial l Statements of Financial Position.....................................................................................................3 / Statements of Activities and ChanLyes io Net Assets —.--------------------.—..4 � Statements of Functional Expenses..............................................................................................5-6 l Statements oF Cash Flows —.------.-----------------'------_____. / | ' 0'l3 Notes toFbuonoiolStatenueo1u--------------------.------------' Bcnn� oo �nn`nUa�ounodoulo1oroo Control over � —',—' ---� -- Financial Reporting' Based no Audit uf Financial Statements ` Performed io Accordance with Government Auditmig Standards .............................................l4-l5 Independent� Auditor's Report ou Compliance aitb � Applicable to Major Federal u and ouInternal � Control over Compliance io Accordance with [D\M Circular A,l33 .......................................\6-l7 � Schedule of Expenditures of Federal Awards.................................................................................... lU / Schedule of Findings and Questioned Costs................................................................................ 19-20 � Summary Schedule nf Prior Audit Findings---------------------.------- 2l ID Notes Uo Schedule of Federal Awards................................................................................................22 ` Schedules of Operatmia Expenses..................................................................................................23 ' ' ' TIGHE, KRE.SS&ORR --—� C�ufied run&c Arroun: The Board of Directors Open Door Clinic of Greater Elgin : 164 Division Street Elgin, Illinois 60120 Independent Auditor's Report We have audited the accompanying statements of financial position of Open Door Clinic of Greater Elgin (a nonprofit organization) as of December 31, 2011 and 2010 and the related statements of activities and changes in net assets, functional expenses and cash flows for the years then ended. These financial statements are the responsibility of the Agency's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audits in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of the Open Door Clinic of Greater Elgin as of December 31, 2011 and 2010 and the changes in its net assets and cash flows for the years then ended in conformity with accounting principles generally accepted in the United States of America. Our audit was conducted for the purpose of forming an opinion on the basic financial statements taken as a whole. The Schedules of Operating Expenses on page 23 is presented for purposes of additional analysis and is not a required part of the basic financial statements. Such information has been subjected to the auditing procedures applied in the audit of the basic financial statements and, in our opinion is fairly stated in all material respects in relation to the basic financial statements taken as a whole. -I- I 595 WELD ROAD a SUITE.9- ELGIN,IL 60123•P:847.695.2700• r:847.695.2748•WWW.TKOCP'A.COM In accordance with Government Auditing Standards, we have also issued our report dated July 31, 2012 on our consideration of Open Door Clinic of Greater Elgin's internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts and grants and other matters. The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the internal control over financial reporting or on compliance. That report is an integral part-of an audit performed in accordance with Government Auditing Standards and should be read in conjunction with this report in considering the results of our audit. Our audit was conducted for the purpose of forming an opinion on the basic financial statements of Open Door Clinic of Greater Elgin taken as a whole. The accompanying schedule of expenditures of federal awards is presented for purposes of additional analysis as required by U.S. Office of Management and Budget Circular A-133,Audits of States, Local Governments, and Non-Profit Organizations, and is not a required part of the basic financial statements. Such information is the responsibility of management and was derived from and relates directly to the underlying accounting and other records used to prepare the financial statements. The information has been subjected to the auditing procedures applied in the audit of the basic financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the financial statements or to the financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. In our opinion, the schedule of expenditures of federal awards is fairly stated in all material respects in relation to the financial statements as a whole. 9 ke , ;dress °4-0(1, L . Elgin, Illinois July 31, 2012 Open Door Clinic of Greater Elgin Statements of Financial Position December 31,2011 and 2010 December 31,2011 December 31, 2010 Assets Current Assets: Cash Accounts receivable 622,800 159,076 Prepaid expense 3,900 5,395 Total current assets 626.700 164,471 Fixed assets,at cost: Equipment 154,308 154,308 Less accumulated depreciation (129,557) (114,465) Net property and equipment. 24,751 39,843 Total Assets 651,451 $ 204,314 Liabilities and Net Assets Current Liabilities: Accounts payable 305,444 $ 41,845 Line of credit - 15,000 Accrued expenses 11,489 512 Total current liabilities 316,933 57,357 Net Assets: Unrestricted 334,518 146,957 Temporarily restricted Permanently restricted - - Total net assets 334,518 146.957 Total Liabilities and Net Assets 651,451. $ 204,314 The accompanying notes are an integral part of the financial statements. -3- .......... J Open Door Clinic of Greater Elgin Statements of Activities and Changes in Net Assets For the Years ended December 31,2011 and 2010 ------------------------Dccember 31,2011------------------------ -------------------------December 31,2010------------------------ I Temporarily Permanently Temporarily Permanently Unrestricted Restricted Restricted Unrestricted Restricted Restricted Funds Funds Funds Total Funds Funds Funds Total Public Support and Revcnuc: United Way 7,384 $ $ 7,384 $ 11,601 $ $ 11,601 Dept of Relm6ilimlim Services 129,320 129,320 119,486 119,486 Department of Public licalth: AFC Consortium 53,898 53,898 98,590 98,590 AIDS Foundation of Chicago- Case Management-Title 1 240,720 240,720 239,059 239,059 Title 111-Part C 330,883 330,883 344,750 344,750 AIDS I-oundation of Chicago-Grant - - 3,750 3,750 Chicago Department of Ilealth-Title 1,11 302,260 302,260 321,909 321,909 Private donations 39,892 39,892 52,804 8,900 61,704 Program service fees 138,062 138,062 144,683 144,683 34013 drug program (net expenses of$1,385,001 a 455,928 455,928 4,394 4,394 and$12,743 respectively) 11,Dept of I'leallh-RIG Grant 99,324 99.324 97.500 97,500 1L Dept of Health-SISTA 4,026 4,026 2,500 2,500 Other 44,844 44,844 55,204 55,204 Fundraising 61,846 61,846 41,023 41,023 Net assets released from restriction - 18,900 (18,900) Total revenue 1,908,387 _7908,387 1,556,153 (10,000) 1,546,153_. Expenses: Program services Primary care 727,750 727,750 640,649 640,649 Case management 405,418 405,418 399,139 399,139 Outreach 135,293 135,293 137,772 137,772 Denistry 65,905 65,905 72,265 72,265 C01111scling 207,871 207,871 143,124 143,124 Management and 8cricnal 178,589 178,589 146,390 146,390 Total expenses 1,720,826 1,720,826 1,539,339 1,539,339 Change in Net Assets 187,561 187,561 16,814 (10,000) 6,814 Net Assets at Beginning of Year 146,957 146,957 130,143 10,000 140,143 Net Assets at End of Year $ 334,518 $ $ $ 146,957 $ $ $ 1416,957 The accompanying notes are an integral part of the financial statements. -4- Open Door Clinic of Greater Elgin Statements of Functional Expenses Years ended December 31,2011 and 2010 -----------------------------------------------Program Expenses---------------------------------------------- Total Primary Case Program Management and 'total Expenses Care Management Outreach Dentistry Counseling Expenses General December 31,2011 Salaries and wages $ 348,340 $ 305,026 $ 69,186 $ 10,335 $ 104,917 $ 837,804 $ 72,277 $ 910,081 Payroll taxes 30,933 26,609 5,472 963 9,491 73,468 6,591 80,059 Employee benefits 46,983 36,825 7,747 2,425 10,323 104,303 10,506 114,809 Supplies and professional fees 190,795 6,610 16,548 41,241 48,921 304,115 5,070 309,185 Occupancy 41,507 1,609 19,809 1,664 3,720 68,309 14,580 82,889 Telephone 10,530 11,191 6,722 4,776 11,215 44,434 1,369 45,803 Technology 961 1,621 961 961 1,922 6,426 - 6,426 Conferences,conventions - and travel 4,872 9,604 7,133 2,470 1,820 25,899 913 26,812 Postage 206 227 482 609 495 2,019 496 2,515 Office supplies 638 121 186 114 399 1,458 258 1,716 Advertising and promotion 587 82 - - 64 733 - 733 Depreciation - - - - - 15,092 15,092 Uncollected fees 50,068 - - - - 50,068 - 50,068 Program expenses 1,208 5,893 1,047 347 1,057 9,552 1,217 10,769 Fundraising expenses - - - - - - 49,936 49,936 Other 122 - - - 13,527 13,649 284 13,933 Total Expenses $ 727,750 $ 405,418 $ 135,293 $ 65,905 $ 207,871 $ 1,542,237 $ 178,589 $ 1,720,826 The accompanying notes are an integral part of the financial statements. -5- Open Door Clinic Of Greater Elgin Statements of Functional Expenses(conlinued) Years ended December 31,2011 and 2010 ---------------------Program Expenses------------------------------------------- Total Primary Case Program Management and Total Expenses Care Management Outreach Dentistry Counseling Expenses General December 31,2010 Salaries and wages $ 276,460 $ 290,157 $ 78,910 $ 8,616 $ 56,929 $ 711,072 $ 71,392 $ 782,464 Payroll taxes 24,261 25,350 7,116 747 5,026 62,500 5,822 68,322 Employee benefits 34,379 39,966 9,817 232 4,164 88,558 10,699 99,257 Supplies and professional fees 212,078 5,225 13,471 49,324 52,486 332,584 2,297 334,881 Occupancy 23,041 14,844 12,717 4,494 9,086 64,182 5,995 70,177 Telephone 10,464 10,093 6,194 3,019 3,583 33,353 3,089 36,442 Conferences,conventions and travel 8,924 8,255 5,922 2,119 2,841 28,061 4,968 33,029 Postage 88 295 805 375 665 2,228 332 2,560 Office supplies 2,451 1,624 2,012 3,237 7,083 16,407 640 17,047 Advertising and promotion 968 - - - 306 1,274 - 1,274 Depreciation - - - - - - 15,270 15,270 Uncollected fees 44,789 - - - - 44,789 - 44,789 Program expenses 2,746 3,330 808 102 955 7,941 1,134 9,075 Fundraising expenses - - - - - - 19,636 19,636 Other - - - - - - 5,116 5,116 Total Expenses $ 640,649 $ 399,139 $ 137,772 $ 72,265 $ 143,124 $ 1,392,949 $ 146,390 $ 1,539,339 The accompanying notes are an integral part of the financial statements. -6- Open Door Clinic of Greater Elgin Statements of Cash Flows Years ended December 31,2011 and 2010 December 31,2011 December 31,2010 Cash used in operations: Change in net assets S 187,561 $ 6,814 Add items not requiring an outlay of cash: Depreciation 15,092 157270 (Increase)decrease in current assets: (increase)decrease in accounts receivable (463,724) 42,648 (Increase)decrease in prepaid expenses 1,495 (5,020) Increase(decrease)in current liabilities: Increase(decrease)in accounts payable 263,599 (55,152) Increase(decrease)in accrued expenses 10,977 440 Cash provided by(used in)operations 15,000 5,000 Cash flows from investing activities: Capital expenditures Equipment Cash provided by(used in)investing activities Cash flows from financing activities: Loan repayments (15,000) (5,000.00) Cash provided by(used in)financing activities (15,000) (5,000) Increase(decrease)in cash for year Cash balance,January I Cash balance,December 31 $ $ Supplemental disclosure Interest expense $ 2,944 $ 2,563 The accompanying notes are an integral part of the financial statements 7 Open Door Clinic of Greater Elgin Notes to the Financial Statements December 31, 2011 Note 1 -Summary of Significant Account Policies Nature of Activities: Open Door Clinic of Greater Elgin is an Illinois not-for-profit corporation that provides testing and counseling related to sexually transmitted diseases. A summary of significant accounting policies of the Agency is presented below to assist the reader in evaluating the financial statements. Method of Accounting: The financial statements of Open Door Clinic of Greater Elgin have been prepared on the accrual basis of accounting and in accordance with U.S. generally accepted accounting principles applicable to non-profit organizations. Revenues are recognized as they are earned and expenses as they are incurred.. Basis of Presentation: Financial statement presentation follows the recommendations of the Financial Accounting Standards Board in its Accounting Standards Codification (ASC) 958-210 (formerly Statement of Financial Accounting Standards (SFAS) No. 117, Financial Statements of Not-for-Profit Organizations. Under SFAS No. 117, Financial Statements of Not-for-Profit). Under FASB ASC 958-210 the Organization is required to report information regarding its finance position and activities according to three classes of net assets: unrestricted net assets, temporarily restricted net assets, and permanently restricted net assets. Unrestricted net assets include undesignated and board-designated sources with no legal or donor imposed restrictions. Temporarily restricted net assets represent net assets subject to donor imposed restrictions which will either be met by the organization's actions or the passage of time. Temporarily restricted net assets are reclassified to unrestricted net assets when the restrictions are met or have expired. These reclassifications are reported in the statement of activities as net assets released from restrictions. At December 31, 2011 and 2010, Open Door Clinic of Greater Elgin had temporarily restricted net assets of $0 and $0 respectively. Permanently restricted net assets represent funds subject to the restrictions of gift instruments requiring the principal to be maintained intact. Investment income may be used for operation and therefore is recorded as unrestricted revenue. Open Door Clinic of Greater Elgin is holding no permanently restricted net assets as of December 31, 2011 and 2010. y , Open Door Clinic of Greater Elgin Notes to the Financial Statements December 31, 2011 Note 1 - Summary of Significant Account Policies (continued) Contributions: Open Door Clinic of Greater Elgin accounts for contributions in accordance with the recommendations in FASB ASC 958-225 (formerly SFAS No. 116, Accounting for Contributions Received and Contributions Made). In accordance with FASB ASC 958- y 225, contributions, grants and contracts received are recorded as unrestricted,temporarily restricted, or permanently restricted support and revenue, depending on the existence and/or nature of any donor restrictions. All contributions are considered to be available' for unrestricted use unless specifically restricted by donors. Unrestricted contributions are recognized when received. All donor-restricted support and revenues are reported as an increase in temporarily or permanently restricted net assets, depending on the nature of the restriction. When a restriction expires (such as when a stipulated time restriction ends or purpose restriction is accomplished) temporarily restricted net assets are reclassified to unrestricted net assets released from restrictions. Estimates: The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. Cash and Cash Equivalents: Open Door Clinic of Greater Elgin, for the purposes of reporting cash flows, cash is defined as cash on hand, amounts held at financial institutions, and short-term highly liquid investments that are readily convertible to known amounts of cash. Investments with an original maturity of three months or less are considered short-term for these purposes. Concentrations of Credit Risk: Open Door Clinic of Greater Elgin maintains its cash balances in several bank accounts at several banks. Accounts at an institution are insured by the Federal Deposit Insurance Corporation (FDIC) up to $250,000. At December 31, 2011 and 2010 the Organization had no accounts in excess of the FDIC insured limits. -9- Open Door Clinic of Greater Elgin ro � l Notes to the Financial Statements December 31,2011 Note 1 - Summary of Significant Account Policies (continued) Property and Equipment: Property and equipment, consisting of office equipment are stated at cost, less accumulated depreciation. Open Door Clinic of Greater Elgin follows the practice of capitalizing, at cost, all expenditures for property and equipment in excess of $5,000. Depreciation is computed on the straight-line basis over the estimated useful lives of the assets. Functional Allocation of Expenses: The costs of providing the various programs and other activities have been summarized on a functional basis in. Accordingly, certain costs have been allocated among the programs and supporting services benefited. Accounts Receivable: Accounts receivable are stated at the amount management expects to collect from outstanding balances and pledges. Management provides for uncollectible amounts through a write-off to an uncollectible fee expense based on its assessment of the current status of individual receivables. There were write-downs for accounts deemed uncollectible for the years ended December 31, 2011 and 2010 of$50,068 and $44,789 respectively. Risk Management: Significant losses are covered by commercial insurance. There have been no significant reductions in insurance coverage. Settlement amounts, if any, have not exceeded insurance coverage for the current year. Donated Property and Services: Donations received in property and services other than cash are recorded at their fair market value on the date of the gift. Donations in property and services whose fair market values are not objectively determinable are omitted from the financial statement in accordance with generally accepted accounting standards. The Organization receives donated services from unpaid volunteers who assist in fund- raising and special projects. No amounts have been recognized in the statement of activities because the criteria for recognition under FASB ASC 958-225 have not been satisfied. -10- Open Door Clinic of Greater Elgin °} Notes to the Financial Statements December 31,2011 1° Note 1 -Summary of Significant Account Policies (continued) Income Tax Status: Open Door Clinic of Greater Elgin is a not-for-profit organization that is exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code and is classified by the Internal Revenue Service as other than a private foundation. Accordingly, a provision for income taxes has not been made on the financial statements. Open Door Clinic of Greater Elgin adopted the implementation of FASB ASC 740 (formerly FIN 48, "Accounting for Uncertainty in Income Taxes"). Under FASB ASC 740, management must evaluate the positions it has taken on tax returns. Management has determined that there are no tax provisions that would result in a more likely than not (50% chance)of being sustained under a potential audit or examination. Note 2 - Fixed Assets Property and equipment at December 31, 2011 and 2010 consist of the following: 2011 2010 Furniture& office equipment $ 154,308 $ 154,308 Less accumulated depreciation (129,557) (114 465 Net property and equipment $� $ Depreciation expense for the years ended December 31, 2011 and 2010 was $15,092 and $15,270 respectively. Note 3 - Lease Commitments Open Door Clinic of Greater Elgin entered into two 36 month lease agreements with a non-related party for administrative office & clinic space in Aurora effective January 1, 2008. Rental expense for the years ended December 31, 2011 and 2010 was $15,598 and $15,720 respectively for the 1344 square foot unit and$8,997 and $9,120 respectively for the 760 square feet unit located adjacent in the same building. Effective January 1, 2012 Open Door Clinic of Greater Elgin renewed their lease agreement for 24 months, the future minimum lease payments are as follows. 2012 $16,800 2013 17.700 $34 50Q -11- Open Door Clinic of Greater Elgin Notes to the Financial Statements December 31,2011 Note 3 -Lease Commitments (continued) 'Open Door Clinic of Greater Elgin's lease agreement with a non-related party for administrative office& clinic space in Elgin expired during the year ended December 31, 2008. Until a formal lease has been signed the agreement is on a month to month basis. Rental expense for the years ended December 31, 2011 and 2010 was 525,396 and 522,536 respectively. Cost of living adjustments may be assessed. Effective January 1, 2012 Open Door Clinic of Greater Elgin renewed their lease agreement for 36 months, the future minimum lease payments are as follows. 2012 $29,496 2013 29,496 2014 29.496 588.488 Note 4- Concentrations Open Door Clinic of Greater Elgin received a substantial portion of its support for the years ended December 31, 2011 from its 340B drug program. The program began in late 2010 and has shown dramatic growth in 2011. Any substantial loss in the amount of revenue generated by this program could significantly affect the organization's programs provided. The revenues and expenses generated by this program for the years ended December 31, 2011 and 2010 are shown below. 2011 2010 340B drug program revenues $1,840,929 517,137 Less 340B drug program expenses (1.385.001) (12,743) Net 340B drug program income S 455,22 -8 4 3 4 Note 5 -Donated Services and Materials Donated assets are recorded at estimated fair value on the date of donation. During the years ended December 31, 2011 and 2010, the organization received in-kind gifts of materials and pro-bono services, but no amounts have been recorded for the value of their materials, in accordance with the provisions of FASB ASC 958-225 (Accounting for Contributions Received and Contributions Made). These donations allowed Open Door Clinic of Greater Elgin to deliver its full range of programs and services in a cost effective manner without having to pay cash for these vital goods and services. -12- I i Open Door Clinic of Greater Elgin t-t Notes to the Financial Statements { December 31,2011 Note 6- Line of Credit Open Door Clinic of Greater Elgin opened a $20,000 revolving line of credit during the calendar year ended December 31, 2008. Interest is to be paid monthly using the stated interest rate. The periodic rate is subject to change and is based on the value of an index. The index in effect for each billing cycle shall be the "Prime Rate" of interest as published in the Money Rate Table of The Wall Street Journal on the 10`h business day prior to the last day of the billing cycle, rounded upward to the nearest .001%. At December 31, 2011 and 2010 Open Door Clinic of Greater Elgin had an open balance of $0 and $15,000 respectively. Note 7 -Contingencies Open Door Clinic of Greater Elgin is currently the defendant in litigation pending in the Illinois Circuit Court for the Sixteenth Judicial Circuit(Kane County), alleging violations of the AIDS Confidentiality Act, 410 ILCS 305, and other claims. The clinic denies the allegations in the complaint and is vigorously defending the lawsuit. Presently; the costs of defending said pending litigation are being covered by insurance; however, the Clinic's insurers have contested coverage for the claims in the lawsuit. The Clinic is continuing to address defense of the lawsuit and obtaining insurance coverage. Note S-Date of Manalzement's Review Subsequent events have been evaluated through the date of this report. It was concluded there are no subsequent events required to be disclosed. -13- 3 j TIGHT, KRESS&ORR �—- Cmtij4cd11ublitAccountanu = Board of Directors " — F Open Door Clinic of Greater Elgin 164 Division Street Elgin, Illinois 60120 Report on Compliance and on Internal Control Over Financial Reporting Based on Audit of Financial Statements Performed in Accordance with Government Auditinz Standards We have audited the financial statements of Open Door Clinic of Greater Elgin as of and for the year ended December 31, 2011 and have issued our report thereon dated July 31, 2012. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards issued by the Comptroller General of the United States. Internal Control Over Financial Reporting Management of Open Door Clinic of Greater Elgin is responsible for establishing and maintaining effective internal control over financial reporting. In planning and performing our audit, we considered Open Door Clinic of Greater Elgin's internal control over financial reporting as a basis for designing our auditing procedures for the purpose of expressing our opinion on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of the Open Door Clinic of Greater Elgin's internal-control over financial reporting. Accordingly, we do not express an opinion on the effectiveness of the Organization's internal control over financial reporting. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent or detect misstatements on a timely basis. A material weakness is a control deficiency, or combination of deficiencies, in internal control such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented, or detected and corrected on a timely basis. Our consideration of internal control over financial reporting was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control over financial reporting that might be deficiencies, significant deficiencies, or material weaknesses. We did not identify any deficiencies in internal control over financial reporting that we consider to be material weaknesses, as defined above. -14- 1595 WELD ROAD e SUITE 9•ELGIN,IL 60123• P:847.695.2700•F:847.695.2748•WWW.TKOCPA.COM Compliance and Other Matters As part of obtaining reasonable assurance about whether Open Door Clinic of Greater Elgin's financial statements are free of material misstatement, we performed tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements, noncompliance with which could have a direct and material effect on the determination of financial statement amounts. However, providing an opinion on compliance with those provisions was not an objective of our audit, and accordingly, we do not express such an opinion. The result of our tests disclosed no instances of noncompliance that are required to be reported under Government Auditing Standards. This report is intended solely for the information and use of the audit committee, management, others within the organization, and federal awarding agencies and pass- through entities and is not intended to be and should not be used by anyone other than these specified parties. 1 tg he tress °- Orr,?.C! Elgin, Illinois July 31, 2012 -1�- TIGHE, KRESS&QRR Cmified Fubl rAxoun.a u Board of Directors Open Door Clinic of Greater Elgin 164 Division Street Elgin, Illinois 60120 Independent Auditor's Report on Compliance With Requirements Applicable to Major Program and on Internal Control over Compliance In Accordance With OMB Circular A-133 Compliance We have audited the compliance of Open Door CIinic of Greater Elgin with the types of compliance requirements described in the U.S. Office of Management and Budget (OMB) Circular A-133 Compliance Supplement that could have a direct and material effect on each of Open Door Clinic of Greater Elgin's major federal programs for.the year ended December 31, 2011. Open Door Clinic of Greater Elgin's major federal programs are identified in the summary of auditor's results section of the accompanying schedule of findings and questioned costs. Compliance with the requirements of laws, regulations, contracts and grants applicable to each of its major federal programs is responsibility of Open Door Clinic of Greater Elgin's management. Our responsibility is to express an opinion on the Organization's compliance based on our audit. We conducted our audit of compliance in accordance with auditing standards generally accepted in the United States of America; the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States; and OMB Circular A-133, Audits of States, Local Governments, and Xon- Profit Organizations. Those standards and OMB Circular A-133 require that we plan and perform the audit to obtain reasonable assurance about whether noncompliance with the types of compliance requirements referred to above that could have a direct and material effect on a major federal program occurred. An audit includes examining, on a test basis, evidence about Open Door Clinic of Greater Elgin's compliance with those requirements and performing such other procedures as we considered necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinion. Our audit does not provide a legal determination of Open Door Clinic of Greater Elgin compliance with those requirements. In our opinion, Open Door Clinic of Greater Elgin complied, in all material respects, with the requirements referred to above that could have a direct and material effect on each of its major federal programs for the year ended December 31, 2011. -16- 1595 WILD ROAD•SLATE 9•ELGIN,IL60123•P:847.695.2700- F:847.695.2748•WWW.TKOCPA.COM f= Internal Control.Over Compliance 6 Management of Open,Door Clinic of Greater Elgin is responsible for establishing and maintaining effective internal control over compliance with the requirements of laws, : regulations, contracts, and grants applicable to federal programs. In planning and performing our audit, we considered Open Door Clinic of Greater Elgin's internal control over compliance with requirements that could have a direct and material effect on a major federal program to determine the auditing procedures for the purpose of expressing our opinion on compliance and to test and report on internal control over compliance in accordance with OMB Circular A-133, but not for the purpose of expressing an opinion on the effectiveness of internal control over compliance. Accordingly, we do not express an opinion on the P.ffP.(1iVP.TP.RS of (lnPn Tlnnr C'linir- of C'r ofPr Rlmr; ;-IF rn t =ntrol over compliance. A deficiency in internal control over compliance exists when the design or operation of a control over compliance does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct noncompliance with a type of compliance requirement of a federal program on a timely basis. A material weakness in internal control over compliance is a deficiency, or combination of deficiencies, in internal control over compliance, such that there is a reasonable possibility that material noncompliance with a type of compliance requirement of a federal program that will not be prevented, or detected and corrected, on a timely basis. Our consideration of.internal control over compliance was for the limited purpose described in the first paragraph of this section and was not intended to identify all deficiencies in internal control over compliance that might be deficiencies, significant deficiencies, or material weaknesses. We did not identify any deficiencies in internal control over compliance that we consider to be material weaknesses, as defined above. This report is intended solely for the information and use of the management, others within the entity, the Board of Trustees, and federal awarding agencies and pass-through entities is not intended'to be and should not be used by anyone other than these specified parties. Elgin, 11I1nois July 31, 2012 -17- t '` Open Door Clini of Greater Elgin Schedule of Expenditures of Federal Awards `r December 31,2011 1 Agency Pass CFDA Through Federal Grantor Number Number Expenditures U.S. Department of Health and Human Services Pass Through From The City of Chicago Department of Public Health Rvan White Title I Funds* Primary Care 93.914 23752 51,729 Administration 93.914 23752 27,841 Mental Health 93.914 23752 78,592 Dental Care 93.914 23752 45,529 Psychosocial 93.914 23752 41,110 Administration 93.914 23752 2,491 Substance Abuse 93.914 23752 31,115 Rollover Funds 93.914 23752 23,853 Pass Through From Illinois Department of Public Health Through Aids Foundation of Chicago As Grantee-Open Door Clinic of Greater Elgin As Subcontractor: Ryan White Part A* Case Management 93.914 240,720 Ryan White Part B 93.9 17 39,352 Rollover Funds 93.917 14,545 Illinois Department of Public Health HIV Testing and Prevention 93.944 99,324 Health Resources and Services* Administration Ryan White Title III Outpatient 93.918 330.883 Total Federal Awards 1,027,085 Total Expenditures by CFDA Number 93.914 542,980 93.917 53,898 93.918 330,883 93.944 99.324 Total Federal Awards 1,027,085 *Major Federal Award Program -18- ' Open Door Clinic of Greater Elgin Schedule of Findings and Questioned Costs For the Year Ended December 31,2011 Section 1 - Summary of Auditor's Results Financial Statements Type of Auditor's Report Issued: Unqualified Internal Control Over Financial Reporting: Material Weaknesses Identified? _ Yes X No Reportable Conditions Identified That Are Not Considered To Be Material Weaknesses? _ Yes X No Noncompliance Material To Financial Statements Noted? _ Yes X No Federal Awards Internal Control Over Major Programs: Material Weaknesses Identified? _ Yes X No Reportable Conditions Identified That Are Not Considered To Be Material Weaknesses? Yes X No Type of Auditor's Report Issued: Unqualified Any Audit Findings Disclosed That Are Required To Be Reported In Accordance With Section 510(a) of Circular A-133 Yes X No Identification of Major Programs: CFDA No. Name of Federal Program 93.914 U.S. Department of Health and Human Services (Ryan White Part A Funds) - Includes Primary Care, Administration, Mental Health, and Dental Care 93.918 U.S. Department of Health and Human Services (Ryan White Part C Funds) - Includes Primary Care,Administration, Mental Health,and Dental Care Dollar Threshold Used.to Distinguish Between Type A and Type B Programs S 300,000 Auditee Qualified as Low-Risk Auditee? X Yes No -19- Open Door Clinic of Greater Elgin Schedule of Findings and Questioned Costs (continued) y For the Year Ended December 31, 2011 Section II - Financial Statement Findings No matters of reportable conditions, material weaknesses or instances of noncompliance related to the financial statements were noted during our audit of the financial statements of Open Door Clinic of Greater Elgin for the year ended December 31, 2011. Section III - Financial.Award Findings and Questioned Costs No reportable conditions, material weaknesses, or material instances of noncompliance were noted during our audit of the financial statements of Open Door clinic of Greater Elgin for the year ended December 31,2011. -20- S� Open Door Clinic of Greater Elgin Summary Schedule of Prior Audit Findings z For the Year Ended December 31,2011 Section II - Financial Statement Findings No matters of reportable conditions, material weaknesses or instances of noncompliance related to the financial statements were noted during our audit of the financial statements of Open Door Clinic of Greater Elgin for the year ended December 31, 2010. Section III-Financial Award Findings and Questioned Costs No reportable conditions, material weaknesses, or material instances of noncompliance were noted during our audit of the financial statements of Open Door clinic of Greater Elgin for the year ended December 31, 2010. -21- +F r t . Open Door Clinic of Greater Elgin Notes to Schedule of Federal Awards December 31, 2011 Note 1 - Basis of Presentation The accompanying schedule of expenditures of federal awards includes the federal grant activity of Open Door Clinic of Greater Elgin for the year ended December 31, 2011 and is present on the GAAP basis of accounting. The information in this schedule is presented in accordance with requirements of OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations. Therefore; some amounts presented in this schedule may differ from amounts presented in, or used in the preparation of, the financial statements. Note 2 - Grants to Sub Recipients The accompanying schedule includes no federal expenditures that have been passed through to sub recipients. Note 3 -Non-Cash Assistance, Federal Insurance & Loans The Agency did not have any non-cash assistance, federal insurance or outstanding loans with respect to the federal awards -22- Open Door Clinic of Greater Elgin Schedule of Operating Expenses For the Years Ended December 31,2011 and 2010 � t December 31,2011 December 31,2010 Salaries and Wages $ 910,081 $ 782,464 Payroll Taxes 80,059 68,322 Employee Benefits 114,809 99,257 Supplies and Professional Fees 309,185 334,881 Occupancy/Insurance 82,889 70,177 Telephone 45,803 36,442 Technology 6,426 Confercace,Conventions and Travel 26,812 33,029 Postage 2,515 2,560 Office Supplies 1,716 17,047 Advertising and Promotion 733 1—174 Depreciation ' 15,092 15,270 Uncollected Fees 50,068 44,789 Program Expenses 10,769 9,075 Fundraising Expenses 49,936 19,636 Other 13,933 5,116 $ 1,720,826 S 1.539;339 -23- llIt•i r te�1i.F!3li:r rt�t!usnyt�: eie:t ryY. 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Roesler 412 Juniper Drive North Aurora, IL 60542 D.Roesler ,opendoorclinic.org (630) 707-7704 OBJECTIVE: A position focused on solidifying the longevity of the mission of an organization. SUMMARY: Over 12 years of experience in creating and implementing solutions for not-for- profit organizations, utilizing capabilities and expertise.in: ➢ Strategic planning ➢ Public speaking &media relations ➢ Procedural development ➢ Key employee recruitment; team building ➢ Program planning ➢ Computer/High-Tech tools ➢ Staff development ➢ Conflict resolution &mediation ACHIEVEMENTS: • Built a team, an infrastructure and a strategic plan for a service organization. Streamlined operations and achieved an average revenue growth rate of 100% annually over four years. • Established Articles of Incorporation and redesigned personnel policies& procedures, officiating operations and establishing financial solvency and cash flow for three service organizations. • Developed marketing plan for large metropolitan service organization. Segmented targeted populations and implemented a new annual marketing campaign. • Recruited, trained, supervised and evaluated therapists, counselors, trainers, accountants, computer technicians, administrative assistants and over 200 volunteers. • Composed contracts and negotiated proposals for federal, state, municipal, foundation and corporate funding. • Conducted employee training seminars for fortune 500 corporations and civic groups. Delivered more than 1500 hours in public presentations as a Key Note speaker for religious and civic purposes. • Provided over 5000 hours in direct counseling services, including such issues as crisis intervention, stress management, marriage, family, abuse/neglect, depression, and grief counseling. • Designed and implemented entrepreneurship program to reduce rural teen crime and increase community development in four downstate Illinois communities. Received Governor's Hometown Awards for each community where program was implemented. page Z..David K Roesler EMPLOYMENT HISTORY: Open Door Clinic, Elgin, IL 60120 Nov. 1, 1999—Present Executive Director YWCA=Metropolitan Chicago, Glen Ellyn, IL 60137 Director of Development& Corporate Services Oct. `97—Oct. 31, 1999 Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL 60194 Coordinator First Offender Program, Aug. 95—Oct. 31, 1999 Range of Motion, Wheaton, IL 60189 Development Consultant April'97 -July`98 Little City Foundation, Palatine, IL 60067 Program Coordinator Jan.`95- Oct. `97 Roesler &Associates, Ottawa, IL 61350 President/CEO Oct. `91 - March. `95 North Central Illinois Youth Service Bureau, Henry, IL 61537 Executive Director June`88 - March.'94 Deer Park Community Church, Ottawa, IL 61350 Senior Pastor Nov. `87 - Oct. '94 EDUCATION/TRAINING: University of California, Los Angeles J&J/UCLA Healthcare Executive Program 2005 Kingsway Bible College &Theological Seminary, Des Moines, IA Bachelor of Arts - Pastoral Theology, 1991. Magna.Cum Laude. Effectiveness Training Inc. , Santa Clara, CA. Certified Effectiveness Training Instructor 1987 United States Professional Tennis Instructors Association Certified Professional Tennis Instructor 1986 University of Illinois at Springfield, IL Bachelor of Arts.-Psychology 1985 PERSONAL/PROFESSIONAL AFFILIATIONS: Avocations include raising 2 sons, sports and chess. Current activities include: ➢ Member, United States Tennis Association 317Gertrude Street (847) 742-0574 Elgin, IL 60123 cbaibandfted@aol.com Barbara A. C®x Harris :.'I U.aff tatiotts Ability to react quickly and professionally to changing corporate demands. ■ Proven ability to handle simultaneous projects and meeting deadlines effectively. • High degree of competence with Microsoft Office and various accounting softwares. ■ Proven ability to interact with staff at all levels. Present Senior Services Associates Elgin,IL Analyst/Accountant December 2002- • Researches and negotiates the most cost effective contracts for elevator,heating, telephone,copier, fax, elevator, fire alarm systems for board approval. • Co-Chair(2008)of annual fundraiser • Aids in preparation and submission of various grant applications • Back up for timely and accurate corporate payroll calculation and input as well as the filing of all required state and federal reports. • Back up for all general ledger entries-preparation and input-as well as month end and C� _p quarterly financial statements and maintaining the supporting detail records. • Prepares supporting schedules for yearly audit. • Analyzed actual to budget variances for 5 offices in 3 different counties. Kearney National Inc. Rolling Meadows,IL Tax Accountant • Applied principles of accounting to analyze financial information.Designed and prepared the necessary supporting schedules for filing state tax returns. • Prepared balance sheet,profit and toss statement and other reports to summarize current and projected company financial position. I.H.S.S. Barrington,IL Senior Corporate Accountant • Responsible for the filing of all necessary state tax and informational returns as well as the compilations and maintenance of the necessary supporting documentation and database. • Responsible for the monthly preparation of profit and loss statements. • Applied principles of accounting to analyze financial information and prepare financial reports. Chicago Board of Trade Chicago,IL Corporate Accountant • Compiled and analvzed financial information to prepare entries to accounts, such as general ledger accounts. • Prepared balance sheets,profit and loss statements and other reports to summarize current and projected company financial position. • Analyzed financial information detailing,assets, liabilities and capital. On' 1982 DePaul University Chicago, IL • Masters in Finance • Earned above average grades while working full time. 1978 DePaul University Chicago, IL • Bachelor of Science in Business Administration • Earned above average grades while working full time. References • Available upon request EXHIBIT B ASSURANCES The SUB-RECIPIENT hereby warrants and represents that it will comply with the regulations, policies, guidelines and requirements with respect to the acceptance and use of CDBG funds in accordance with the ACT and the City of Elgin policies. Also, the SUB-RECIPIENT certifies with respect to the grant that: 1. It possesses legal authority to make a grant submission to the CITY and to execute a community development and housing program; 2. Its governing body has duly adopted or passed as an official act, a resolution, motion or similar action authorizing the person identified as the official representative of the SUB-RECIPIENT to execute this Agreement, all understandings and assurances contained herein, and directing the authorization of the person identified as the official representative of the SUB-RECIPIENT to act in connection with the execution of this Agreement and to provide such additional information as may be required. 3. Prior to submission of its application to the City, the SUB-RECIPIENT has: (A) Met the citizen participation requirements of 570.301(b) and has provided citizens with: (1) The estimate of the amount of CDBG funds proposed to be used for activities that will benefit persons of low and moderate income; and (2) Its plan for minimizing displacement of persons as a result of activities assisted with CDBG funds and to assist persons actually displaced as a result of such activities; (B) Prepared its application in accordance with the policies of the City of Elgin and made the application available to the public; 4. The grant will be conducted and administered in compliance with: (A) Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352 42 U.S.C. Sec 2000d et seq.) and implementing regulations issued at 24 CFR Part 1; (B) Title VIII of the Civil Rights Act of 1968 (Pub. L. 90-208), as amended; and that the SUBGRANTEE will administer all programs and activities related to housing and community development in a manner to affirmatively further fair housing; (C) Section 109 of the Housing and Community Development Act of 1974, as amended;and the regulations issued pursuant hereto; (D) Section 3 of the Housing and Urban Development Act of 1968, as amended; (E) Executive Order 11246-Equal Opportunity, as amended by Executive Orders 11375 and 12086, and implementing regulations issued at 41 CFR Chapter 60; (F) Executive Order 11063-Equal Opportunity in Housing, as amended by Executive Order 1229, and implementing regulations at 24 CFR Part 107; Page 14 of 19 (G) Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and implementing regulations when published in effect; (H) The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and implementing regulations when published for effect; (I) The relocation requirements of Title 11 and the acquisition requirements of Title III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended, and the implementing regulations at 24 CFR Part 42, as required under 24 CFR 570.606; (J) The labor standards requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issues to implement such requirements; (K) Executive Order 11988 relating to the evaluation of flood hazards and Executive Order 11738 relating to the prevention, control and abatement of water pollution; (L) The flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (Pub. L. 93-234); (M) The Fair Housing Act(42 U.S.C. 3601-20); 5. Its notification, inspection, testing and abatement procedures concerning lead-based paint will comply with 570.608; and 6. When a grant is in excess of $100,000 it will comply with all applicable standards, orders, or requirements issued under Section 308 of the Clean Air Act (42 U.S.C. 1857(h), Section 508 of the Clean Water Act (33 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency regulation (40 CFR Part 15), which prohibit the use under nonexempt Federal contracts, grants or loans, of facilities included on the EPA list of Violating Facilities. The provision shall -require reporting of violations to the County, HUD, and to the AESOP Assistant Administrator for Enforcement (EN-329). 7. It has developed its application so as to give maximum feasible priority to activities which benefit low and moderate income families or aid in the prevention or elimination of slums or blight; (the application may also include activities which the SUB-RECIPIENT certifies are designed to meet other community development needs having a particular urgency because existing conditions pose a serious and immediate threat to the health or welfare of the community, and other financial . resources are not available); 8. It is following the current City of Elgin Consolidated Plan which has been approved by HUD pursuant to 570.306; and 9. It will not attempt to recover any capital costs of public improvements assisted in whole or in part with funds provided under Section 106 of the ACT or with amount resulting from a guarantee under Section 108 of the ACT by assessing any amount against properties owned and occupied by persons of low and moderate income, including any fee charged or assessment made as a condition of obtaining access to such public improvements, unless: (1) funds received under Section 106 of the ACT are used to pay the proportion of such fee or assessment-that relates to the capital costs of such public improvements that are financed from revenue sources other than Page 15 of 19 under Title I of the ACT; or (2) for purposes of assessing any amount against properties owned and occupied by low and moderate income persons, the SUB-RECIPIENT certifies that it lacks sufficient funds received under Section 106 of the ACT to comply with the requirements of subparagraph(1) above. 10. The SUB-RECIPIENT 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 SUB- RECIPIENT'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 SUB-RECIPIENT'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 such conviction; (E) Notifying the City of Elgin's Community Development Department within ten (10) 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;. (G) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (A), (B), (C), (D), (E) and (F). 11. It has adopted and is enforcing a policy prohibiting the use of excessive force by law enforcement agencies within its jurisdiction against any individuals engaged in nonviolent civil rights demonstrations. Page 16 of 19 12. In regards to lobbying, the SUB-RECIPIENT certifies: (A) No Federal appropriated funds have been paid or will be paid, by or on behalf of the SUB-RECIPIENT, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (B) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (C) The SUB-RECIPIENT shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than 510,000 and not more than 5100,000 for each such failure. Pase 17 of 19 EXHIBIT C EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION Community Development Block Grant Program City of Elgin The undersigned understands and agrees that it is a SUB-RECIPIENT of the Community Development Block Grant Program of the CITY. The undersigned also agrees there shall be no discrimination against any employee who is employed in carrying out work from the assistance received from the CITY and HUD, or against any applicant for such employment, because of race, color, religion, sex, age or national origin, including but not limited to employment, upgrading, demotion or transfer; recruitment or recruitment advertising; lay off or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The SUB-RECIPIENT further agrees to the following: (1) It will incorporate or cause to be incorporated into any grant contract, loan, grant insurance or guarantee involving Federally assisted construction work, or modification thereof, which is paid for in whole or in part with funds obtained from the Community Development Block Grant program, the language contained in HUD Equal Employment Opportunity Regulations at 42 CFR 130.15(b), in Executive Order 11246, as amended by Executive Orders 11375 and 12006, and implementing regulations issued in 41 CFR Chapter 60. (2) - It will be bound by said equal opportunity clause with respect to its own employment practices when it participates in any Community Development Block Grant Program construction. (3) It will assist and cooperate actively with the CITY, HUD, and the Secretary of Labor in obtaining the compliance of contractors and subcontractors with the equal opportunity clause and the rules, regulations and relevant orders of the Secretary of Labor. (4) It will furnish the CITY, HUD, and the Secretary of Labor such information as they may require for the supervision of such compliance, and will otherwise assist the CITY and HUD in the discharge of primary responsibility for securing compliance. (5) It will refrain from entering into any contract or contract modification subject to Executive Order 11246 of September 24, 1965, with a contractor debarred from or who has not demonstrated eligibility for government contracts and federally assisted construction contracts pursuant to the Executive Order. (6) It will carry out such sanctions and penalties for violation of the equal opportunity clause as may be imposed upon contractors and subcontractors by the Secretary of Labor, the CITY or HUD. (7) In the event that SUB-RECIPIENT fails or refuses to comply with the undertaking, the CITY, or HUD may take any or all of the following actions: cancel, terminate or suspend, in whole or in part, this grant, refrain from extending any further assistance to the SUB-RECIPIENT until satisfactory assurance of future compliance has been received; and refer the case to HUD for appropriate legal proceedings. Page 18 of 19 SUB-RECIPIENT: The Open Door Clinic of Lealter Elgin 164 Division Street, 6`h nois 60120 BY: David M. Roesle r Executive Director DATE: ATTEST: FALegal Dept\Agreement\CDBG-Open Door Clinic-2012-13-legal redlined-02-19-13.docx I Page 19 of 19