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ASSURANCES - A

ACCEPTANCE OF GRANT CONDITIONS AND TERMS

(CDBG-CV, CDBG, HOME)

As the duly authorized representative for:

(Agency name)

I understand and agree to the grant conditions and terms described in the Notice of Funding

Availability (NOFA) and application packet for VETERANS PSH. Should the El Paso City Council

award VETERANS PSH funding for:

(Project Name)

I understand that the award may be revoked by City Council should:

(Agency Name)

fail to adhere to the schedule agreed upon for the project. I agree and acknowledge that if the award

of funding is revoked by City Council at any time, the agency will not be entitled to any costs or

damages from the City. Additionally, if there have been monies expended for project expenses, these

monies will be reimbursed to the City.

Name Signature

Title Date

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ASSURANCES – B

ASSURANCE OF APPLICANT ELIGIBILITY

FOR NON-PROFIT ORGANIZATIONS

As President (Chairman) of the Board of Directors of

, I

certify that the agency, as applicant for VETERANS PSH from the City of El Paso, Texas, has non-

profit tax-exempt status under Section 501(c)(3) of the Internal Revenue Service Code at the time of

application.

I also certify that the agency has formal authorization from its Board of Directors to submit a

VETERANS PSH funding proposal to the City of El Paso, Texas.

I further certify that a copy of the Articles of Incorporation, organizational by-laws, IRS 501(c)(3)

certification letter, and the most current agency Audit Report or Audited Financial Statement is being

included with the VETERANS PSH funding proposal.

Signature:

Name:

Date:

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ASSURANCES – C

ASSURANCE OF COMPLIANCE WITH ORDINANCE NO. 9779

As of

(Position Title) (Agency)

I certify on behalf of the stated organization that as applicant for VETERANS PSH funding from the

City of El Paso, the entity will comply with the City of El Paso's Ordinance No. 9779 (Non-

Discrimination Against Disabled Persons) and all requirements imposed by said Ordinance. The

organization further certifies that in accordance with the foregoing requirements, no qualified person,

shall on the basis of disability, be excluded from participation in or be denied the benefits of any

program or activity receiving financial assistance from or operated by the City of El Paso, or be

subjected to discrimination with respect to employment by Grantees of the City of El Paso's financial

assistance.

Signature:

Name:

Date:

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ACCESSIBILITY/LETTER OF ASSURANCE- D

TO: ADA Accessibility Coordinator

DATE: __________________________

perezjc@lpasotexas.gov

(915) 212-3005

As required by the City of El Paso, the applicant for funding, assistance from the City of El Paso, or contracting with the

City of El Paso named below agrees to comply with the City of El Paso Ordinance #9779, Non-Discrimination Against

Disabled Persons, and all requirements imposed by said ordinance. The applicant agrees that in accordance with the foregoing

requirements, no qualified person shall, on the basis of disability, be excluded from participation in or be denied the benefits

of any program or activity receiving financial assistance from or operated by the City of El Paso, or be subjected to

discrimination with respect to employment by any recipient of City assistance.

Listed below are the exact addresses for all sites to be used for the proposed project. (If a section is not applicable, note reason

- e.g. “Office in home” or “no rehearsal space.”). If you require further space, you may attach an additional sheet.

Street Address

City

State

Zip

Administration Offices:

Program Sites:

Attached is a current Self-Evaluation form for each of the above sites. (If a completed Self-Evaluation form is on file at the

proposed site, the applicant may provide a copy provided all information is current. If the site has been modified, or if a

Self-Evaluation has not been performed on the site, the applicant must complete and submit a current form.

If the ADA Accessibility Coordinator has found a proposed site to be in Conditional or Non-Compliance status, the applicant

must also submit a copy of the Transition Plan which is a written agreement between the location’s owners or occupants

and the City detailing required changes to the site and the time frame to complete these changes. (There is no form for the

Transition Plan.)

The applicant understands that any change in the approved site requires notification of the ADA Accessibility Coordinator in

Capital Improvement Department at least 60 days prior to use of the new site. Questions regarding the above information

may be addressed to the contact person listed below. The applicant will expect notification by letter of the accessibility status

of each site.

Name of Or

ganization

Name of Contact Person

dress

Phone of Contact Person

Phone Signature of Authorized Representative

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GUIDELINES/SELF-EVALUATION FOR COMMUNITY DEVELOPMENT

AND CITY OF EL PASO SUBRECIPIENTS

Agency Name: Telephone:

Address: Date:

Age of Facility:

Scope of Work

New Construction Renovation/Alteration Addition to Existing Building N/A Explain

Person Filling Out Report:

Reference

ADAAG & New construction must meet 2015 ADA Accessibility Guidelines and 2015 Texas

TAS 201 Accessibility Standard Requirements.

ADAAG & Renovations/Alterations of an area of must meet the 2015 ADA Accessibility

TAS 202 Guidelines and 2015 Texas Accessibility Requirements which includes upgrading

parking, the accessible route to and through the renovated area, the

restrooms/bathrooms, drinking fountains, and public phones.

UFAS 4.6. 1.) Parking Spaces

ADAAG & a. How many total parking spaces?

TAS 208, b. How many are accessible for the disabled?

502 c. How wide is accessible parking space? (8’ min.)

d. How wide is accessible access aisle? (5’ or 8’ for a van space)

e. Is the accessible parking space on the shortest accessible route of travel from

adjacent parking to the accessible entrance? Yes No

If no, please explain:

f. Is at least one space a van accessible space (8’ space and an 8’ access aisle or 11’

space with a 5 access aisle)? For every six accessible parking spaces one must be

a van accessible space. Yes No

If not, please explain:

Reference

g. If a car is parked in the accessible space, is the sign visible? (sign on pole or wall

mounted at least 60” above the parking surface) Yes No

h. Is/are the space/s and access aisle/s level with no slope over 1:50 (2%) in any

direction? (Flat) Yes No

UFAS Table 4.1.1 &

Figure 9

ADAAG/TAS

Table 208.2 & Figure

502.2 and 502.3

Table 4.1.1

Figure 9, 4.6, 502.2

Figure 502.3

UFAS 4.5 2.) Is there a continuous, smooth, level, hard-surfaced pathway at least 36" ADAAG/TAS

wide, with no level changes greater than 1/2" from accessible parking to the

206 & Chap. 4 and entrance? Yes No

UFAS 4.8 3.) If there are changes in level, are ramps provided? Yes No

ADAAG/TAS a. What is total change in height (inches)? (more than ¼”)

405 b. What is the ramp length (feet)? (1’ in length for each inch rise)

c. Are handrails provided? (required if more than 6” rise) Yes No

UFAS 4.13.6 4.) Maneuvering Clearance at Door (Doors are part of the Accessible route

305, 404 and must be brought into compliance if an area of primary function is

renovated.)

What are the dimensions of the level maneuvering area at front entrance

door? (4’ X5’ min)

Does the door swing in or out?

Indicate approach direction and dimensions of level maneuvering space

by drawing entry dimensions as shown in the example below.

Reference

Figure 25

Entry sketch

UFAS 4.13.5 5.) What is the clear width of front entrance when door is open? (32” min.)

ADAAG/TAS 404

UFAS 4.5 6.) Is floor non-skid surface, or low-pile carpet of 1/2" or less and firmly

ADAAG/TAS 403 attached? Yes No

If no, please explain:

UFAS 4.13.5 7.) All interior doors must provide clear width of 32" when open. Complete

ADAAG/ TAS the following chart for interior doors. (List doors in building)

405 a. Do all doors comply? Yes No

Clear Width Clear Width

Room (inches) Room (inches)

Add additional sheets if needed.

UFAS 4.13.9

ADAAG/ TAS

405

b. Do all accessible doors have handles, pulls, latches, locks, and operating

devices that have a shape that is easy to grasp with one hand and does

not

require tight grasping, pinching or twisting of the wrist to operate? (No Knobs)

Yes No

If no, please explain:

Reference

UFAS 4.10

8.)

The building is story(ies) high.

ADAAG/TAS

Does the building have an elevator? Yes No

407 If yes, complete the following:

a. What is elevator door width? (36” min)

b. What are inside dimensions? (51” X 68”)

c. How high above floor are call buttons? (48”)

d. How high are highest car control buttons? (48”)

e. Do control buttons have raised characters or Braille?

If no, please explain:

UFAS 4.4.1

ADAAG/TAS

9.)

Are all wall-mounted elements (phones, fire extinguishers, signs, etc.)

mounted with their leading edges at or below 27 inches?

(204, 307

Yes No If no, please explain:

Does the element protrude over 4 inches from the wall? Yes No

If the element protrudes over four inches from the wall into the accessible

route, is the element protected by means of curb, ground mounted object, etc.?

Yes No If no, please explain:

Figure 8

10.) Restroom Facilities (If an area of primary function is renovated then the restrooms must be

brought into compliance.)

Are toilet facilities provided in rooms having multiple stalls or in individual rooms?

Multiple Stalls Individual Rooms

UFAS 4.16 - If multi-stall:

4.23 a. What is clear width at main restroom entrance when door is open? (32” min.)

ADAAG/TAS

213, Chap. 6 b. What is the clear width of the aisle to the accessible stall? (36” min.)

What are the dimensions of the accessible stall? (56” X 60” min.)

Depth Width

What is the distance from the wall to the center of the toilet. (16” to 18”)

Does stall door swing in or out?

Does accessible stall/toilet have grab bars? Yes No

1. Length of grab bars (36” back 42” side)

2. Location (side/back)

3. Mounting height above floor (33” to 36”)

What is toilet seat height from floor? (17” to 19”)

Is the flush valve on the open side of the toilet?

i. What is lavatory rim height from floor? (34” max)

j Do clearances comply with Fig. 31 & Fig. 32 (below)? Yes No

k. Is there clear floor space of 30" x 48" minimum? (Fig. 31) Yes No

l. Are hot water and drain pipes below sink insulated or otherwise covered?

Yes No

m. What are heights of top and bottom edges of accessible mirror from floor?

Bottom edge (40” max.) Top edge (74” min.)

n. Are all dispensers easy to reach and no more than 48” from floor to bottom of

dispenser? Yes No

If individual toilet rooms are provided, indicate configuration below:

1. Room dimensions (Must have 5’ diameter turning area)

2. Does the door swing into the clear floor space of any fixture? Yes No

3. Fixture heights and location

a. What is toilet seat height from floor? (17” to 19”)

b. What is the distance from the wall to the center of the toilet. (16” to 18”)

c. What is lavatory rim height from floor? (34” max.)

d Does accessible toilet have grab bars? Yes No

1. Length of grab bars (36” back 42” side)

2. Location (side/back)

3. Mounting height above floor (33” to 36”

e Is there a clear space of 5 feet from the wall to the nearest fixture adjacent to the

toilet (sink or urinal) and is flush valve on wide side of toilet? Yes No

Do clearances comply with Fig. 31 & Fig. 32 (above)? Yes No

Is there clear floor space of 48" x 30" minimum? (Fig. 31) Yes No

Are hot water and drain pipes below sink insulated or otherwise covered?

Yes No

Reference

i. What are heights of top and bottom edges of accessible mirror from floor?

j. Bottom edge (40 in. max) Top edge (74 in. min.)

k. Are all dispensers easy to reach and no more than 48” from floor to bottom

dispenser? Yes No

UFAS 4.15 11.) Is at least one water fountain accessible; no more than 36" in height measured

ADAAG/TAS from the floor or ground surface to the spout with a 30" x 48” clear floor space in 211,

602 front of the water fountain? (If an area of primary function is being renovated then the water

fountains must be made compliant.) Yes No

If no, please explain:

UFAS 4.31.3 12.) Is at least one phone accessible to the mobility impaired (no more than 48"

ADAAG/TAS from the floor)? Yes No

217, 704 If no, please explain:

UFAS 4.31.9 13.) Do you have a Telecommunications Device for the Deaf (TDD)?

ADAAG/TAS Yes No

217, 704 If no, please explain how service is provided to individuals with hearing

impairments?

UFAS 4.28.2, 14.) Are emergency warning signals both audible and visual?

4.28.3 Yes No

ADAAG /TAS If no, please explain:

205, 702

15.) Is program information that is available in print, available on audio tape or in an

alternative method? Yes No

If no, please explain:

16.) Are all public meetings accessible (with sign language interpreters) and in

accessible locations? Yes No

If no, please explain:

Reference number is from Uniform Federal Accessibility Standards, Americans with Disabilities Act

Accessibility Guidelines, and Texas Accessibility Standards.

In the case that non-compliant elements are found and structural changes are needed, develop a

transitional plan setting forth the steps necessary to complete such changes or alterations. The

transitional plan shall contain, at a minimum, identification of physical barriers that limit

accessibility; description of methods to make facilities accessible; time schedule for taking each

necessary step; costs of changes; and name of person responsible for implementation of plan. Please

attach this information to the self-evaluation.

Please be advised that you may have further obligations under the

Americans with Disabilities Act.

For

questions or further information regarding these forms, please contact:

Accessibility & ADA Coordinator

perezjc@lpasotexas.gov

212-3005

Please return Guidelines/Self-Ev

aluations and Transitional Plan along with the proposal application

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