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Home My WebLink About2012-290 2012-290 CITY OF SAN BERNARDINO COMMUNITY DEVELOPMENT BLOCK GRANT(CDBG)PUBLIC SERVICE PROGRAM 2013-2014(YEAR 4, 2010-2015) PUBLIC SERVICE APPLICATION Application Released: December 20, 2012 Mandatory Workshop: January 22, 2013 APPLICATION DEADLINE: FEBRUARY 14, 2013 AT 5:00 P.M. 1. A mandatory CDBG/ESG Pre-Application Workshop will be held on Monday, January 22, 2013 in the Multipurpose Room of City Hall (level B) from 9:30 a.m. to 12:00 p.m. for those public service agencies interested in applying for funds. Please call the City Manager's Office at (909) 384-5122 to reserve a space. Questions regarding the program may be e-mailed to Mims Br @sbcity.org. 2. One (1)application per agency. 3. Applications must be postmarked no later than February 14, 2013 at 5:00 p.m. Late applications will not be accepted. Failure to submit required documentation will result in immediate rejection of your application. INSTRUCTIONS: Complete this application in Microsoft Word. DO NOT HANDWRITE THIS APPLICATION, if you need access to a computer or another accommodation to complete this application, please contact Brandon Mims at Mims_Br @sbcity.org. Answer all questions, be concise and detailed as possible, and attach the required and supporting documentation. Your Program must have a City of San Bernardino address, business license and have been in operation for three(3)years. 1. GENERAL INFORMATION Organization Name: Address: City: State: California Zip Code: Telephone Number: Fax Number: Federal ID#501(c)(3) Number: Is your Organization Faith Based?: n Yes ❑ No Application Contact Person Name: <<This person should attend the workshop on January 22,2013. Application Contact Person Phone: Application Contact E-Mail Address: 2. PROGRAM DESCRIPTION Program Name: Executive Director Name: Executive Director Phone: Program Administrator: Program Administrator Phone: Main Office Address: Program Address: (NOTE: If you program serves San Bernardino, but is not located in San Bernardino, please explain how here: NOTE:The section below is required. Failure to enter the information below will result in immediate rejection of your application. Staff will not enter this information on your behalf Census Tract and Block Group Number of Program's Office (not the main office): (www.census.gov) Census Tract and/or Block Group Number(s) of Clientele to be Served: CDBG Grant Amount Requested: $00.000 2012-290 3. PROGRAM SUMMARY(100 WORD MAX) Write a brief summary of your Program for the upcoming fiscal year. This brief summary or Mission Statement will be used in the rating sheets provided to the Community Development Citizen Advisory Committee (CDCAC). Program Summary-Type Here<<Begin typing in this gray box. If you need assistance with completing this application please contact our office at(909)384-5122. Use "Word Count"to ensure you have not written more than 100 words. 4. WHY DO YOU NEED FUNDS?WHAT WILL YOU DO WITH THEM (100 WORD MAX) Please describe the Program you are requesting CDBG funding for... How will this program impact San Bernardino residents? Provide a detailed explanation. Be sure to include quantifiable objectives such as the number of proposed households that will be benefited and how many City of San Bernardino residents you propose will benefit from the program. Please provide an explanation as to how your organization will track its program participants. Why do you need the money? -Type Here <<Begin typing in this gray box. If you need assistance with completing this application please contact our office at(909)384-5122. 5. PROGRAM OBJECTIVE(100 WORD MAX) What community need or issue will your program address? How will this program impact San Bernardino residents? Be sure to include a description of your program's target population. (Who will benefit from the service you are providing) ... Program Objective - Type Here <<Begin typing in this gray box. If you need assistance with completing this application please contact our office at(909)384-5122. 6. ORGANIZATIONAL STRUCTURE(100 WORD MAX) NOTE: YOU MUST COMPLETE THIS SECTION AND ATTACH A CURRENT ORGANIZATION CHART. FAILURE TO DO SO WILL RESULT IN THE IMMEDIATE REJECTION OF YOUR APPLICATION. Describe your organization's experience in implementing your proposed program. Describe your Organizational Structure and the experience of the staff who will be implementing your proposed program. ... Organization Structure- Type Here «Begin typing in this gray box. If you need assistance with completing this application please contact our office at(909)384-5122. City of San Bernardino,APPLICATION DEADLINE: FEBRUARY 14,2013 AT 5:00 P.M. Community Development Block Grant-2013-2014 I Page 1 2012-290 7. EXPLAIN YOUR ORGANIZATION'S FINANCIAL CAPACITY(100 WORD MAX) What other funding, both private and public, does your agency receive? How will you continue to provide the proposed service, should your Organization not be funded? Financially Sound? - Type Here «Begin typing in this gray box. If you need assistance with completing this application please contact our office at(909)384-5122. 8. WHY SHOULD YOU BE FUNDED OVER ANOTHER AGENCY?(100 WORD MAX) Please provide an explanation as to why you feel your proposed service should be funded, the goal your proposed service strives to achieve, and how it will benefit the citizens of San Bernardino. Why you?-Type Here «Begin typing in this gray box. If you need assistance with completing this application please contact our office at(909)384-5122. 7. What objective best describes the purpose your activity seeks to achieve with this year's CDBG funds: ❑ Create Suitable Living Environments relates to activities that are designed to benefit communities, families, or individuals by addressing issues in their living environment. This objective related to activities that are intended to address a wide range of issues faced by low and moderate income persons, from physical problems with their environment, such as poor quality infrastructures, to social issues such as crime prevention, literacy, or elderly health services. ❑ Provide Decent Housing focuses on housing activities whose purpose is to meet individual family or community housing needs. ❑ Create Economic Development applies to activities related to economic development, commercial revitalization or job creation. 8. What outcome best describes the change or result your Activity seeks to achieve with this year's CDBG funds (Please Check One). ❑ Availability/Accessibility activities make services, infrastructure, public services, public facilities, housing, or shelter available or accessible to low and moderate income people. For instance, opening a day care center for students in a neighborhood high school so that educational opportunities remain available and accessible to young mothers. ❑ Affordability activities provide affordability to low- and moderate-income persons. For instance, providing free housing counseling to low and moderate income families to enable them to obtain such assistance without charge. ❑ Sustainability activities are aimed at improving communities, to make them more livable or viable. For instance, establishing programs in a local community center to provide neighborhood children with structured activities after school. City of San Bernardino,APPLICATION DEADLINE: FEBRUARY 14,2013 AT 5:00 P.M. Community Development Block Grant-2013-2014 I Page 2 2012-290 12. PROGRAM BENEFIT To be eligible for CDBG funding, a program must address at least one of the following categories. CHECK ONE OR MORE CATEGORIES WHICH MAY BE APPLICABLE TO YOUR PROGRAM. A. ❑ Benefit to low/moderate income persons(at least fifty-one percent(51%) of program beneficiaries). 1. Is your Program primarily designed to serve: Yes No Elderly: ❑ ❑ Minority: ❑ ❑ Disabled: ❑ ❑ At-Risk Children ❑ L Illiterate Persons: ❑ ❑ Battered Spouses: n ❑ Homeless Persons: ❑ ❑ Migrant Farm Workers: ❑ ❑ 2. Does your Program have income eligibility requirements? ❑ ❑ (*All individuals assisted with CDBG must provide some form of income verification) B. Prevention or elimination of slum and blight. If yes,a copy ❑ ❑ of the area study must be included. C. Urgent health and safety condition (as specified in regulations ❑ ❑ and applicable only if a natural disaster) D. Number of unduplicated SB Residents served for FY2011/2012** (People) (**Your 2012-2013 numbers will not be available yet) Number of unduplicated SB Residents to be served for FY2013/2014*** (People) (***This is an estimate) E. Has your agency received CDBG funding from the City? ❑ ❑ If yes, please indicate year,grant amount, Program Name and purpose below: YEAR AMOUNT PROGRAM NAME PURPOSE City of San Bernardino,APPLICATION DEADLINE: FEBRUARY 14,2013 AT 5:00 P.M. Community Development Block Grant-2013-2014 I Page 3 2012-290 13. PROPOSED PROJECT BUDGET A. Should your organization be funded, please complete the following budget breakdown in an amount not to exceed $15,000. Include matching funds amount and name of organization providing those funds. ITEM CDBG MATCH AMOUNT AMOUNT ORGANIZATION SALARIES FICA/SUI LIFE/HEALTH/DENTAL INSURANCE ACCOUNTANT/BOOKKEEPING LEGAL RENT UTILITIES OFFICE SUPPLIES CONSUMABLE SUPPLIES WORKER'S COMP INSURANCE EQUIPMENT INSURANCE TRAVEL MILEAGE @.505 TOTALS City of San Bernardino,APPLICATION DEADLINE: FEBRUARY 14,2013 AT 5:00 P.M. Community Development Block Grant-2013-2014 I Page 4 2012-290 14. REQUIRED SUBMISSIONS AND CERTIFICATION ALL APPLICANTS MUST SUBMIT ONE(1)ORIGINAL AND TWO(2)COPIES OF: INITIAL REQUIRED ITEMS Complete Community Development Block Grant Application List of Board of Directors Organizational Chart Resume of Program Administrator Resume of Fiscal Officer Conflict of Interest Statement Articles of Incorporation Financial Statement and 2010 Audit(Prepared by a qualified and independent entity and no year later than 2010) Final Determination Letter of Tax Exempt Status 501(C)(3) Board of Directors'Authorization to Request Funds(Copy of Board Minutes) Board of Directors' Designation of Authorized Official Proof of Property Ownership or Long Terms Lease Agreement(5 Year Minimum) ADDRESS APPLICATION PACKAGE AS FOLLOWS: City of San Bernardino, City Clerk's Office 300 North D Street, 2nd Floor San Bernardino, CA 92418 The undersigned certifies that: A. The information contained in this CDBG Application is complete and accurate; and B. The sponsor shall comply with all federal and City policies and requirements affecting the CDBG Program. SIGNATURE OF APPLICATION CONTACT DATE «Enter your name and title here SIGNATURE OF AUTHORIZED OFFICIAL/EXECUTIVE DIRECTOR DATE «Enter your name and title here City of San Bernardino,APPLICATION DEADLINE: FEBRUARY 14,2013 AT 5:00 P.M. Community Development Block Grant-2013-2014 I Page 5 2012-290 CDBG REGULATIONS(24 CFR 570) ELIGIBLE SUBRECIPIENTS 24 CFR 570.500. Definitions (c) "Subrecipient" means a public or private non-profit agency, authority or organization, or an entity described in.... 570.204 (c), receiving CDBG funds from the recipient to undertake activities eligible for assistance. 24 CFR 570.204. Special Activities by Certain Subrecipients (a) Eligible Activities. The recipient may provide CDBG funds (e.g. grant or loan) to any of the three types of subrecipients specified in paragraph (c) of this section to carry out neighborhood revitalization, community economic development, or energy conservation project. Such a project may include activities listed as eligible under this subpart, and activities not otherwise listed as eligible under this subpart, except those described as ineligible..., when the recipient determines that such activities are necessary or appropriate to achieve its community development objectives. Notwithstanding that such recipients may carry out activities as part of such project that are not otherwise eligible under this subpart, this provision does not authorize: (1) Provisions of public services that do not meet the requirements of(subpart)570.201(e)(1)and (2): (2) Provision of assistance to a for-profit business that does not comply with the requirements of (subpart) 570.203(b)(special economic development activities);... (b) Eligible Subrecipients. The following are subrecipients authorized to receive assistance under this section. (1) Neighborhood Based Non-Profit Organizations. A neighborhood-based non-profit organization is an association or corporation, duly organized to promote and undertake community development activities on a not-for-profit basis within a neighborhood. An organization is considered to be neighborhood based if the majority of either its membership, clientele, or governing body are residents of the neighborhood where activities assisted with CDBG funds are to be carried out... (2) Section 301(d)Small Business Investment Companies. A Section 301(d) Small Business Investment Company is an entity organized pursuant to Section 301(d) of the Small Business Investment Act of 1958 (15 U.S.C. 681(d)), including those which are profit making. (3) Local Development Corporations. A local development corporation is: (i) An entity organized pursuant to Title VII of the Headstart, Economic Opportunity, and Community Partnership Act of 1974(42 U.S.C. 2981) or the Community Economic Development Act of 1981 (42 U.S.C. 9801); (ii) An entity eligible for assistance under Section 502 or 503 of the Small Business Investment Act of 1958(15 U.S.C. 696); (iii) Other entities incorporated under State and local law whose membership is representative of the area of operation of the entity (including non-resident owners of businesses in the area) and which are similar in purpose,function, and scope to those specified in paragraph (c)(3)(i)or(ii)of this section;or (iv) A State development entity eligible for assistance under Section 501 of the Small Business Investment Act of 1958(15 U.S.C.695). City of San Bernardino,APPLICATION DEADLINE: FEBRUARY 14,2013 AT 5:00 P.M. Community Development Block Grant-2013-2014 I Page 6 2012-290 ,..„ Fcannmicie ekipmentSgency . 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SRC LANG ” SR _...., a = 6 I v L „ JO i, ?, Pa. *1 'N,Pw ,t 051,34^,. �p�'� 9y ,,,v'.'-, . ,,. ;._ ya ffi =°@oc, ,. `moo, i m, 44b1� � -�' � 3�/ N� � d J �4t4rp1 � �,;,�s" I "'§�$t 5 ��"'"k a� s t .4 C, g 'k} . 1.0' - tea. �z z 3- ;ice y I d , € - .3:0 ; er Use this map to find the Census Tract of your program or log onto www.census.eov. Do not call the program office;we are not able to assist you with determining this information. City of San Bernardino,APPLICATION DEADLINE: FEBRUARY 14,2013 AT 5:00 P.M. Community Development Block Grant-2013-2014 I Page 7