Community development block grant program

APPLICATION GUIDE

The County of San Mateo and cities of Redwood City, Daly City, South San Francisco, and San Mateo jointly developed a Consolidated Community Funding Application. The application has three parts:

1) Required Supporting Documentation

2) Consolidated Application

3) Supplemental specific to the individual jurisdictions (Information required varies by specific jurisdiction).

*NOTE: The County of San Mateo is using this Consolidated Application for the following activities only: Public Services, Fair Housing, Minor Home Repair Programs, Micro-Enterprise Assistance.
All Daly City applications are due by January 18, 2013 at 5:00pm.  No late applications will be accepted.

*NOTES:

• 
  Daly City applicants must sign and submit 2 hard copies of the application and project budget worksheet and one copy of each supporting document.
  

Contacts:

City of South San Francisco: Alin Lancaster: 650-829-6621, Alin.Lancaster@ssf.net

City of Redwood City: Rhonda Coffman: 650-780-7299, rcoffman@redwoodcity.org

County of San Mateo: Rosa Mendoza: 650-802-5037, rmendoza@smchousing.org

City of San Mateo: Chris Wahl: 650-522-7229, wahl@cityofsanmateo.org

City of Daly City: My Do-Kruse, 650-991-8068, mdo@dalycity.org, 333 90th Street, Daly City, CA 94015

Required Supporting Documentation

Please attach ONE copy of each of the following items along with your application and label with corresponding attachment numbers.

1. 
    Resolution authorizing application and designation of signatory (please remember to schedule a board meeting if needed)
   

• 
  Board of Directors (for non-profit entities)
  
• 
  Governing body (for public entities)
  

2. 
    Proof of 501(c)3 / tax-exempt status (for non-profit entities)
   
3. 
    By-laws (for non-profit entities)
   
4. 
    Articles of Incorporation (for non-profit entities)
   
5. 
    Board roster, including:
   

• 
  Name, Company, Years on Board
  
• 
  Meeting dates for previous 12 months
  
• 
  Number of years allowed for each board term
  

6. 
    Organizational chart for entire organization
   
7. 
    Certified financial audit no more than 1 fiscal year old, prepared by a CPA, and:
   

• 
  Management letters (if applicable)
  
• 
  A-122 and A-133 Single Audit (for entities that receive more than $500,000 in federal funding) OR
  
• 
  A letter from your Executive Director certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit.
  

8. 
    Organization Operating Budget– ONLY REQUIRED FOR NEW APPLICANTS.
   
   1. 
       Current (FY12-13) Agency Operating Budget
      
   2. 
       Proposed (FY13-14) Agency Operating Budget
      
9. 
    Mission Statement
   
10. 
     Non-Discrimination Policy
    
11. 
     Reasonable Accommodations Policy
    

General Information

1. 
   Project Title:      
   
2. 
   Project Location / Address:      
   
3. 
   Provide a one sentence project summary:      
   
4. 
   Organization Name:      
   

Address:      

Telephone:       Website:      

Type of Applicant:  Non-Profit  For Profit  Public Agency

Does your agency serve:  Persons  Households

5. 
   Contact Person / Project Administrator:      
   

Title:       Telephone / TDD:      

Fax:       Email:      

6. 
   Name of Agency Director:      
   

Address:      

Telephone:       Fax:       Email:      

7. Name of Fiscal Officer:      

Address:      

Telephone:       Fax:       Email:      

8. 
   Name of person authorized by Board to execute documents and designate authorized agents:      
   

Address:      

Telephone:       Fax:       Email:      

8. 
   Provide days and hours of regularly scheduled operation:
   

     

8. 
   Provide organization’s DUNS and Tax ID (TIN) numbers:
   DUNS:       TIN:      
   

*A DUNS (Data Universal Numbering System) number is required for CDBG funding and is assigned by Dun & Bradstreet, Inc.  If your organization does not currently have a DUNS number, you can obtain one at: http://fedgov.dnb.com/webform. This process can take up to 30 days.
Application Authorization

This application was prepared by:

Signature: Date:

Name:       Title:      

This application is submitted by:

I/We certify that the information and statements contained herein are true, accurate and complete to the best of my/our knowledge. I/We authorize the funding agency to verify any information pertaining to this application. I/We acknowledge and understand that if facts and/or information herein are found to be misrepresented, it may constitute grounds for rejection of the application or default of the allocation for which this application is being made.

Signature: Date:

Name:       Title:      

Signature: Date:

Name:       Title:      

Project Information:

8. 
   Type of funding requested - please check one box.
   

County of San Mateo:	CDBG Public Service 	CDBG Minor Rehab 	CDBG Micro-Enterprise 	CDBG Fair Housing 	ESG 
Daly City:	CDBG Public Service 	CDBG Minor Rehab 	CDBG Micro-Enterprise 	CDBG Fair Housing 
	CDBG Public Facilities 	CDBG Acq./ Rehab 	HOME New Const. 	HOME Acq./ Rehab 
Redwood City:	CDBG Public Service 	CDBG Minor Rehab 	CDBG Micro-Enterprise 	CDBG Fair Housing 	HOME CHDO 
	CDBG Public Facilities 	CDBG Acq./ Rehab 	HOME New Const 	HOME Acq./ Rehab 	HSFA 
S. San Francisco:	CDBG Public Service 	CDBG Public Facilities 	CDBG Minor Rehab 	HOME Fair Housing 	RDA Housing 

8. 
   Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction.
   

     

8. 
   Assessment of Need: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community.
   

     

8. 
   Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year.
   

     

8. 
   Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date.
   

     

8. 
   Collaboration: Describe partnerships with other organizations/agencies, the nature of the partnership, and how it relates to the proposed project.
   

     

8. 
   Impact: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants – describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants – describe how your program would be impacted without these funds.
   

     

8. 
   Project Beneficiaries/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below, please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits (at the end of this application).
   

a. Indicate the total number of low-income beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low-income is 80% of Area Median Income or below.

b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income.

Jurisdiction	a. Number of low-income beneficiaries.		b. All beneficiaries to be served.
	Individuals	Households	Individuals	Households
Daly City	     	     	     	     
Redwood City	     	     	     	     
City of San Mateo	     	     	     	     
County of San Mateo	     	     	     	     
South San Francisco	     	     	     	     
Totals:	     	     	     	     

8. 
   Income Verification: Describe how you obtain and verify beneficiary income data. Third party documentation or client income signatures on certification forms must be available on file for review at all times.
   

     

8. 
   Population Served: Identify the primary population served by your program. If more than one population is served, rank them numerically. You may only use a number once. Starred (*) categories are not considered ‘presumed benefit’ under HUD.
   

     	Victims of Domestic Violence	     	Persons with AIDS
     	Abused Children	     	Migrant Farm Workers
     	Persons with Disabilities	     	Illiterate Persons
     	Elderly Persons	     	Persons exiting incarceration*
     	Chronically Homeless Persons	     	Low-Income Youth *
     	Temporarily Homeless Persons	     	Other (describe)*      

21. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE: If you are a new applicant, please provide your best estimation.

Race & Ethnicity	Daly City Population	Daly City % by Ethnicity	Low Income by Ethnicity served by your Program last year
Total	101,123	100%	     
White	23,842	23.6%	     
Hispanic	23,929	23.7%	     
Asian	56,267	55.6%	     
African American	3,600	3.6%	     
Pacific Islander	805	0.8%	     
Native American	404	0.4%	     
Other	16,205	16.0%	     

b. Based on the percentages that you indicate your organization served, describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts.

     

22. 
    Capital Project, Housing Construction, Acquisition or Rehabilitation Projects ONLY:
    

a. Environmental Impact - Will the proposed activities disturb lead based paint, displace low income persons or households, demolish or convert low income housing? If so, check all applicable boxes:

Lead Based Paint Relocation One for One Replacement

b. If your activity will require displacement and/or relocation, then describe your “Relocation Strategy”:
     
c. Will your activity trigger Davis Bacon prevailing wages?
YES  NO
The payment of prevailing wages under Davis-Bacon is required if:

• 
  CDBG funds are part of a construction contract of $2,000+ for non-housing construction activities.
  
• 
  CDBG funds are used towards the rehabilitation of housing of 8+ units.
  
• 
  HOME funds are used for a contract for construction of affordable housing with 12 or more HOME-assisted units.
  
• 
  The housing development (rehab/new construction) will have 9+ project-based vouchers.
  

22. 
    Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount.
    

     

22. 
    Staff List: List below key staff members who work on this program, their job titles, responsibilities and qualifications.
    

Position Title	Name of Staff Person	Job Responsibilities	Qualifications
     	     	     	     
     	     	     	     
     	     	     	     
     	     	     	     
     	     	     	     
     	     	     	     

2013 INCOME LIMIT SCHEDULE

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
(effective December 2012)

Number of Persons In Household	Extremely Low Income	Very Low Income	Low Income
1	$22,200	$36,950	$59,100
2	$25,350	$42,200	$67,550
3	$28,500	$47,500	$76,000
4	$31,650	$52,750	$84,400
5	$34,200	$57,000	$91,200
6	$36,750	$61,200	$97,950
7	$39,250	$65,450	$104,700
8	$41,800	$69,650	$111,450

A family or other household is eligible for Community Development Block Grant assistance

if its total income is below these limits

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